21

Addiction Addiction

Counseling Counseling

Competencies Competencies

The Knowledge, Skills, and The Knowledge, Skills, and 

AAttitudes of Professional Practice ttitudes of Professional Practice

TAP 21

Technical Assistance Publication Series

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov
Other Technical Assistance Publications (TAPs) include:

TAP 2 Medicaid Financing for Mental Health and Substance Abuse Services for Children and 

Adolescents PHD581

TAP 13 Confidentiality of Patient Records for Alcohol and Other Drug Treatment BKD156

TAP 14 Siting Drug and Alcohol Treatment Programs: Legal Challenges to the NIMBY Syndrome 

BKD175

TAP 17 Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas BKD174

TAP 19 Counselor’s Manual for Relapse Prevention With Chemically Dependent Criminal Offenders 

(SMA) 06-4217

TAP 20 Bringing Excellence to Substance Abuse Services in Rural and Frontier America BKD220

TAP 21 Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional 

Practice (SMA) 08-4171

TAP 21-ACompetencies for Substance Abuse Treatment Clinical Supervisors (SMA) 08-4243

TAP 22 Contracting for Managed Substance Abuse and Mental Health Services: A Guide for Public 

Purchasers BKD252

TAP 23 Substance Abuse Treatment for Women Offenders: Guide to Promising Practices 

 (SMA) 08-3929

TAP 24 Welfare Reform and Substance Abuse Treatment Confidentiality: General Guidance for 

Reconciling Need to Know and Privacy BKD336

TAP 26 Identifying Substance Abuse Among TANF-Eligible Families (SMA) 05-4089

TAP 28 The National Rural Alcohol and Drug Abuse Network Awards for Excellence 2004, Submitted 

and Award-Winning Papers (SMA) 10-4183

TAP 29 Integrating State Administrative Records To Manage Substance Abuse Treatment System 

 Performance (SMA) 09-4268

TAP 30 Buprenorphine: A Guide for Nurses (SMA) 09-4376

TAP 31 Implementing Change in Substance Abuse Treatment Programs (SMA) 09-4377
ADDICTION COUNSELING

COMPETENCIES

The Knowledge, Skills, and 

Attitudes of Professional Practice

Technical Assistance Publication (TAP) Series

21

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Rockville, MD 20857
ii

Acknowledgments

A number of people deserve recognition for their tireless and dedicated work on this document. The publication was originally conceived and written by the National Addiction Technology Transfer Center (ATTC) 

Curriculum Committee. The Committee, one of six national committees designed to serve the ATTC Network, 

comprises representatives from several ATTC Regional Centers and the ATTC National Office. This group was 

responsible for the original 1998 publication and for the 2000 draft on which this updated edition is based 

(see page v). A second Committee convened in 2005 to update and finalize the current document (see page 

vi). Karl D. White, Ed.D., and Catherine D. Nugent, M.S., served as the Center for Substance Abuse Treatment 

(CSAT) ATTC Project Officers. Christina Currier served as the CSAT Government Project Officer. 

This publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program 

(KAP) contract number 270-04-7049. Lynne MacArthur, M.A., A.M.L.S., served as the JBS KAP Executive Project 

Co-Director; Barbara Fink, RN, M.P.H., served as JBS KAP Managing Project Co-Director; Dennis Burke, M.S., 

M.A., served as KAP Deputy Director for Product Development; and Jennifer Frey, Ph.D., served as the KAP 

Deputy Director for Knowledge Application. Other JBS KAP personnel included Elliott Vanskike, Ph.D., Senior 

Writer; Wendy Caron, Editorial Quality Assurance Manager; Frances Nebesky, M.A., Quality Control Editor; 

and Pamela Frazier, Document Production Specialist.

Disclaimer

The views, opinions, and content expressed herein are those of the expert panel and do not necessarily reflect the views, opinions, or policies of CSAT, the Substance Abuse and Mental Health Services Administration 

(SAMHSA), or the U.S. Department of Health and Human Services (HHS). No official support of or endorsement by CSAT, SAMHSA, or HHS for these opinions or for particular instruments, software, or resources is 

intended or should be inferred.

Public Domain Notice

All materials appearing in this volume except those taken directly from copyrighted sources are in the public 

domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation 

of the source is appreciated. However, this document may not be reproduced or distributed for a fee without 

the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be ordered from SAMHSA’s Publications Ordering Web page at http://www.store.samhsa.

gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). The document can 

be downloaded from the KAP Web site at http://www.kap.samhsa.gov.

Recommended Citation

Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No. (SMA) 

08-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.

Originating Office

Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for 

Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry 

Road, Rockville, MD 20857.

HHS Publication No. (SMA) 08-4171

First printed 2006

Revised 2007, 2008, 2009, and 2011
 

 

 

 

 

 

contents
 

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Curriculum Committees v
 

1998 National ATTC Curriculum Committee v
 

2005 Update Committee vi
 

Foreword vii
 

Introduction 1 

Section 1: Transdisciplinary Foundations 5 

I. Understanding Addiction 7 

II. Treatment Knowledge 13 

III. Application to Practice 19 

IV. Professional Readiness 27 

Section 2: Practice Dimensions 35 

I. Clinical Evaluation 37 

II. Treatment Planning 53 

III. Referral 67 

IV. Service Coordination 77 

V. Counseling 99 

VI. Client, Family, and Community Education 131 

VII. Documentation 141 

VIII. Professional and Ethical Responsibilities 151 

Section 3: Additional Resources 161
 

Cultural Competency 162 

Internet Resources 163 

Attitudes Bibliography 164 

Recovery Bibliography 166 

Section 4: Appendices 169
 

A. Glossary ......................................................... 170
 

B. The Competencies: A Complete List ................................... 176
 

C. National Validation Study: Defining and Measuring the Competence
 

of Addiction Counselors ............................................. 188
 

D.Complete Bibliography.............................................. 196
 

E. Other Contributors................................................. 224
 

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iii 
iv
v

Curriculum Committees

1998 National ATTC Curriculum Committee

Affiliations indicated below are those at the time of the work.

David A. Deitch, Ph.D. (Chair)

Pacific Southwest ATTC

University of California San Diego

La Jolla, California

G.E. Carrier, Ph.D.

Representing the Texas ATTC

Alvin Community College

Alvin, Texas

Steven L. Gallon, Ph.D.

Northwest Frontier ATTC

Oregon Health and Science University

Salem, Oregon

Paula K. Horvatich, Ph.D.

Mid-Atlantic ATTC

Virginia Commonwealth University

Richmond, Virginia

Mary Beth Johnson, M.S.W.

ATTC National Office

University of Missouri–Kansas City

Kansas City, Missouri

Hendi Crosby Kowal, M.P.H.

DC/Delaware ATTC

Danya International, Inc.

Silver Spring, Maryland

Linda Nicholas

Great Lakes ATTC

University of Illinois–Chicago

Jane Addams School of Social Work

Chicago, Illinois

Alan M. Parsons, M.S.W., ACSW

Northeastern States ATTC

State University of New York at Albany

Albany, New York

Nancy Roget, M.S., MFT, LADC

Mountain West ATTC

University of Nevada–Reno

Reno, Nevada

Susanne R. Rohrer, RN, M.B.A.

Center for Substance Abuse Treatment

Substance Abuse and Mental Health 

 Services Administration

Washington, D.C.

Anne Helene Skinstad, Psy.D.

Prairielands ATTC

University of Iowa

Iowa City, Iowa

Patricia L. Stilen, LCSW, CADAC

Mid-America ATTC

University of Missouri–Kansas City

Kansas City, Missouri

Susan A. Storti, RN, M.A.

ATTC of New England

Brown University

Providence, Rhode Island

Elleen M. Yancey, Ph.D.

Southeast ATTC

Morehouse School of Medicine

Atlanta, Georgia
vi

2005 Update Committee

Paula K. Horvatich, Ph.D. (Chair)

Mid-Atlantic ATTC

Virginia Commonwealth University 

Richmond, Virginia

Carol Davidson, M.S.W., CDP

Evergreen Treatment Services

Seattle, Washington

Steven L. Gallon, Ph.D.

Northwest Frontier ATTC

Office of Alcohol and Drug Abuse Programs

Salem, Oregon

Michael Hoge, Ph.D.

Annapolis Coalition

Yale University

New Haven, Connecticut

James Holder, M.A., LPC-S, MAC

National Association for Alcohol and 

 Drug Addiction Counselors

McLeod Behavioral Health

Florence, South Carolina 

Mary Beth Johnson, M.S.W.

ATTC National Office

University of Missouri–Kansas City

Kansas City, Missouri

Linda Kaplan, M.A.

National Association for Children 

 of Alcoholics

Rockville, Maryland

Captain Florentino (Tino) 

 Merced-Galindez, M.S.N., RN

Center for Substance Abuse Prevention

Substance Abuse and Mental Health 

 Services Administration

Rockville, Maryland

Randolph Muck, M.Ed.

Center for Substance Abuse Treatment

Substance Abuse and Mental Health 

 Services Administration

Rockville, Maryland

Paul D. Nagy, M.S., LCAS, LPC, CCS

Duke Addictions Program

Duke University Medical Center

Durham, North Carolina

Nancy Roget, M.S., MFT, LADC

Mountain West ATTC

University of Nevada–Reno

Reno, Nevada

Gerard J. Schmidt, M.A., LPC, MAC

NAADAC–The Association for Addiction 

 Professionals

Valley HealthCare System

Morgantown, West Virginia

Michael Shafer, Ph.D.

Pacific Southwest ATTC

Tucson, Arizona

James L. Sorensen, Ph.D.

San Francisco General Hospital

University of California–San Francisco

San Francisco, California

Patricia L. Stilen, LCSW, CADAC

Mid-America ATTC

University of Missouri–Kansas City

Kansas City, Missouri

Deborah Stone, Ph.D.

Center for Mental Health Services

Substance Abuse and Mental Health 

 Services Administration

Rockville, Maryland

Pamela Waters, M.Ed., CAPP

Southern Coast ATTC

Florida Certification Board

Tallahassee, Florida

Addiction Counseling Competencies
vii

Foreword

Counselors who treat people with substance use disorders do life-changing work on a daily 

basis, amid difficult circumstances that include staff shortages, high turnover, low salaries, 

and scant program funding. Counselors come to this important work by various paths and 

with vastly different skills and experience. The diversity of backgrounds and types of 

preparation can be a strength, provided there is a common foundation from which counselors 

work. This publication addresses the following questions: What professional standards should 

guide substance abuse treatment counselors? What is an appropriate scope of practice for 

the field? Which competencies are associated with positive outcomes? What knowledge, 

skills, and attitudes (KSAs) should all substance abuse treatment professionals have in 

common? 

Workforce development is essential to the field of substance use disorder treatment. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) has included 

workforce development in its Matrix of Priority Programs. A major focus of this workforce 

development strategy is improving the competencies of professionals in the field. This updated 

edition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies: 

The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a key 

component of that strategy.

In 1998, in cooperation with its Addiction Technology Transfer Center (ATTC) Network, 

SAMHSA published TAP 21, a comprehensive list of 123 competencies that substance abuse 

treatment counselors should master to do their work effectively. TAP 21 has been used to 

develop and evaluate addiction counseling curricula, advise students, and assess counseling 

proficiencies. 

The overarching competencies in this updated version of TAP 21 remain largely unchanged 

from the original TAP 21. The KSAs have been changed from those in the 1998 edition when 

necessary, in light of new thinking in the field. The competencies and the KSAs in practice dimensions that address clinical evaluation and treatment planning have been revised to reflect 

changes in the field. The competencies are defined by sublists of the KSAs needed to master 

each competency. Bibliographies have been supplemented with new publications through 2005. 

The format has been improved to make the information more accessible and useful.

SAMHSA’s TAP series provides a flexible format for the timely transfer of important technical 

information to the substance abuse treatment field. This updated version of TAP 21 exemplifies 

the flexibility of the TAP format. We are grateful to the members of the ATTC Network and staff 

and to all those who participated in the validation and updating of these competency lists.

Pamela S. Hyde, J.D.

Administrator

Substance Abuse and Mental Health Services Administration

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration
viii
1

Introduction

In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the 

Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies: 

The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical 

Assistance Publication (TAP) 21. Developed by the National Curriculum Committee of the 

Addiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competencies 

that are essential to the effective practice of counseling for psychoactive substance use 

disorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors need 

to become fully proficient in each competency.

TAP 21 has been widely distributed by SAMHSA’s National Clearinghouse for Alcohol and Drug 

Information (NCADI) and the ATTC Network. It has become a benchmark by which curricula are 

developed and educational programs and professional standards are measured for the field of 

substance abuse treatment in the United States. In addition, it has been translated into 

several languages.

Because the ATTC Network is committed to technology transfer, after the initial publication 

of TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting good 

information. It entails transmitting scientific knowledge in a way that makes it understandable, 

feasible to implement in a real-world setting, and supportable at a systematic level—in other 

words, getting the right information across in a way that makes it useable. The National 

Curriculum Committee examined how best to package and present TAP 21 to help people 

learn key elements and adopt new strategies. The result was a revision of TAP 21—a process 

that was begun in 2000, was completed in 2005, and resulted in the current publication. 

History of The Competencies

In 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographically 

dispersed across the United States and in Puerto Rico and the U.S. Virgin Islands. Since its 

inception, the ATTC Network has collaborated with diverse international, national, State, 

regional, and local partners from multiple disciplines to recruit qualified addiction treatment 

practitioners and enhance academic preparation and professional development opportunities 

in the substance abuse treatment field. 

The National Curriculum Committee, composed of ATTC Directors, was established at the 

Network’s inaugural meeting. The committee’s initial charge was to collect and evaluate 

existing addiction educational and professional development curricula and establish future 

priorities for ATTC curriculum development. This effort led to researching existing practice 

and professional literature and defining an extensive list of addiction practice competencies 

determined to be essential to effective counseling for substance use disorders. These initial 

competencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.
2

In addition to its own work, the National Curriculum Committee reviewed and incorporated 

other publications on the work of addiction counselors.1

 In 1995 the committee’s work 

resulted in the ATTC publication Addiction Counselor Competencies. Subsequent to this 

publication, the ATTCs conducted a national survey to validate the competencies (see appendix 

C). Results supported virtually all of the competencies as being essential to the professional 

practice of addiction counseling. 

In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a national 

leadership group to evaluate the need for model addiction counselor training. After careful 

deliberation, the group concluded that much of the work to define such a curriculum standard 

had already been accomplished by the ATTC National Curriculum Committee and the ICRC in 

the National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996 

Role Delineation Study,

2

 respectively. 

Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used 

as a national standard. CSAT convened a panel—The National Steering Committee for Addiction 

Counseling Standards (NSC)—that comprised representatives from five national educational, 

certification, and professional associations. The NSC was successful in achieving unanimous 

endorsement of the Addiction Counselor Competencies—a milestone in the addiction 

counseling field.

Based on this foundation, the National Curriculum Committee began to delineate the KSAs 

that undergird each competency statement. Input was solicited from a number of key national 

organizations and selected field reviewers. In 1998 CSAT published the results of this groundbreaking work as TAP 21 (The Competencies).

After TAP 21 was published, the National Curriculum Committee systematically conducted 

focus groups and a national survey to elicit feedback from the field about the impact of TAP 21. 

Although feedback was uniformly positive and thousands of copies of TAP 21 were disseminated 

through SAMHSA’s NCADI and the ATTC Network, refinements were needed to improve the utility 

of the publication and enhance its effect in both the addiction practice and educational systems.

Feedback obtained from the survey and the focus groups indicated a need for additional information to help the field incorporate the competencies into daily practice. Feedback also suggested 

that there was no need to change the competencies. The most common suggestions were to 

refine the 1998 publication by presenting the content in a more user-friendly fashion and linking 

it to professional literature and specific applications. The National Curriculum Committee revised 

TAP 21 in 2000 based on the feedback of dedicated addiction practice and education professionals; however, this revision was never published.

A new Update Committee was convened in 2005 to update the revised 2000 edition with literature published between 2000 and 2005. The Update Committee consisted of some of the original 

members from the National Curriculum Committee; representatives from NAADAC—The Association for Addiction Professionals, CSAT, the Center for Mental Health Services, the Center for 

Substance Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition; treatment providers; and experts in addiction research. The current updated edition 

retains all of the feedback-based improvements of the 2000 revised version and adds relevant 

Addiction Counseling Competencies

1 Birch and Davis Corporation (1986). Development of Model Professional Standards for Counselor Credentialing. Dubuque, IA:

 Kendall/Hunt Publishing. 

 

2 International Certification and Reciprocity Consortium (ICRC)/Alcohol and Other Drug Abuse (1991). Role Delineation Study for

 Alcohol and Other Drug Abuse Counselors. Raleigh, NC: ICRC.
3

literature published after 2000. In addition, the competencies and KSAs of several practice 

dimensions, in particular those that address clinical evaluation and treatment planning, 

were rewritten to reflect current best practices. 

What You Will Find Inside

The Model

When creating The Competencies, the National Curriculum Committee recognized a need to 

emphasize three characteristics of competency: knowledge, skills, and attitudes. Many hours 

were spent conceptualizing a differentiated model when designing TAP 21—a model that could 

address general KSAs necessary for all practitioners dealing with substance use disorders while 

explaining the more specific needs of professional substance abuse treatment counselors. 

The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction, 

treatment knowledge, application to practice, and professional readiness. The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e.g., 

medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with 

individuals with substance use disorders.

The second section of the model specifically addresses the professional practice needs, or 

practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling 

are outlined. Many additional competencies may be desirable for counselors in specific settings. 

Education and experience affect the depth of the individual counselor’s knowledge and skills; 

not all counselors will be experienced and proficient in all the 

competencies discussed. The 

National Curriculum Committee’s goal for the future is to 

help ensure that every addiction 

counselor possesses, to an appropriate degree, each competency listed, regardless of setting 

or treatment model. 

The relationship of the components in the competencies 

model is conceptualized as 

a hub with eight spokes (see 

figure 1). The hub contains the 

four transdisciplinary foundations that are central to the work 

of all addiction professionals. 

The eight spokes are the practice dimensions, each containing 

the competencies the addiction 

counselor should attain to master each practice dimension.

Introduction

Figure 1. Components in the Competencies Model
4

Recommended Readings

Journal articles, book chapters, and other critical literature for each transdisciplinary foundation 

and practice dimension have been reviewed and included in this document. Moreover, separate 

bibliographies on attitudes and recovery have been added, as have lists of Internet and cultural 

competency resources. These can be found in section 3. 

Appendices

Appendices include a glossary (appendix A), a complete list of the competencies (appendix B), 

a summary of the results of the Committee’s National Validation Study of The Competencies

(appendix C), a complete bibliography with a detailed overview of the methodology used for 

literature searches (appendix D), and a list of people who acted as field reviewers or provided 

research assistance (appendix E). 

Companion Volume—TAP 21-A

As a companion to this volume on counselor competencies, CSAT is publishing TAP 21-A, 

Competencies for Substance Abuse Treatment Clinical Supervisors, which discusses the qualities 

and abilities integral to supervising substance abuse treatment clinicians. 

Uses of The Competencies

Since its inception, The Competencies has been improving addiction counseling and addiction 

counselor education across the country in a number of ways. The most common reported 

applications have been in curriculum/course evaluation and design for higher education; 

personal professional development; student advising, supervision, and assessment; assessment 

of competent practices; design of professional development and continuing education programs; and certification standards/exams. Examples of how The Competencies is being used 

are given on the following pages:

Montana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Illinois. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Nebraska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

New York. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Missouri. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Puerto Rico. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

International Applications. . . . . . . . . . . . . . . . . . . . . . 59

New England. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Idaho, Oregon, and Washington. . . . . . . . . . . . . . . . . . 74

Nevada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Florida. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Virginia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Northeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Idaho. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Washington. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

California. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Oregon and Wisconsin. . . . . . . . . . . . . . . . . . . . . . . . . 135

Iowa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Alaska, Hawaii, Idaho, Oregon, and Washington. . . . . 155

Addiction Counseling Competencies
5

Section 1:

Introduction to the Transdisciplinary Foundations

The Transdisciplinary Foundations

Addiction professionals work in a broad variety of disciplines but share 

an understanding of the addictive process that goes beyond the narrow 

confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built 

on four common foundations.

This section focuses on four sets of competencies that are transdisciplinary 

in that they underlie the work not just of counselors but of all 

addiction professionals. The four areas of knowledge identified here 

serve as prerequisites to the development of competency in any of the 

addiction-focused disciplines.

The Four Transdisciplinary Foundations

I. Understanding Addiction

II. Treatment Knowledge

III. Application to Practice

IV. Professional Readiness

Regardless of professional identity or discipline, each treatment provider 

must have a basic understanding of addiction that includes knowledge of 

current models and theories, appreciation of the multiple contexts within 

which substance use occurs, and awareness of the effects of psychoactive 

drug use. Each professional must be knowledgeable about the continuum 

of care and the social contexts affecting the treatment and recovery 

process.

Each addiction specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of individual clients. Each 

professional must be prepared to adapt to an ever-changing set of challenges and constraints.

Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective 

practice in addiction counseling depends on the presence of attitudes 

reflecting openness to alternative approaches, appreciation of diversity, 

and willingness to change.

The following knowledge and attitudes are prerequisite to the development 

of competency in the professional treatment of substance use 

disorders. Such knowledge and attitudes form the basis of understanding 

on which discipline-specific proficiencies are built.
6
7

Transdisciplinary Foundation

I

UNDERSTANDING ADDICTION
8
9

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

TF I. Understanding Addiction

Competency 1:

Understand a variety of models and theories of addiction and other problems 

related to substance use.

Knowledge

X Terms and concepts related to theory, 

etiology, research, and practice.

Scientific and theoretical basis of model

from medicine, psychology, sociology, 

religious studies, and other disciplines.

Criteria and methods for evaluating 

models and theories.

Appropriate applications of models.

How to access addiction-related literature

from multiple disciplines.

Attitudes

X Openness to information that may differ 

from personally held views.

Appreciation of the complexity inherent 

in understanding addiction.

Valuing of diverse concepts, models, 

and theories.

Willingness to form personal concepts

through critical thinking.

Competency 2:

Recognize the social, political, economic, and cultural context within which 

addiction and substance abuse exist, including risk and resiliency factors that 

characterize individuals and groups and their living environments.

Knowledge

X Basic concepts of social, political, 

economic, and cultural systems and their

impact on drug-taking activity.

The history of licit and illicit drug use.

Research reports and other literature 

identifying risk and resiliency factors for

substance use.

Statistical information regarding the 

incidence and prevalence of substance 

use disorders in the general population 

and major demographic groups.

Attitudes

X Recognition of the importance of 

contextual variables.

Appreciation for differences between 

and within cultures.
10

Addiction Counseling Competencies

Competency 3:

Describe the behavioral, psychological, physical health, and social effects of 

psychoactive substances on the person using and significant others.

Knowledge

X Fundamental concepts of pharmacological

properties and effects of all psychoactive

substances.

X The continuum of drug use, such as 

initiation, intoxication, harmful use, 

abuse, dependence, withdrawal, craving,

relapse, and recovery.

X Behavioral, psychological, social, and

health effects of psychoactive substances.

X The effects of chronic substance use 

on clients, significant others, and 

communities within a social, political,

cultural, and economic context.

X The varying courses of addiction.

X The relationship between infectious 

diseases and substance use.

Attitudes

X Sensitivity to multiple influences in the

developmental course of addiction.

X Interest in scientific research findings.

Competency 4:

Recognize the potential for substance use disorders to mimic a variety of 

medical and mental health conditions and the potential for medical and 

mental health conditions to coexist with addiction and substance abuse.

Knowledge

X Normal human growth and development.

X Symptoms of substance use disorders that

are similar to those of other medical and/

or mental health conditions and how 

these disorders interact.

X The medical and mental health conditions 

that most commonly exist with addiction

and substance use disorders.

X Methods for differentiating substance use 

disorders from other medical or mental 

health conditions.

Attitudes

X Willingness to reserve judgment until

completion of a thorough clinical 

evaluation.

X Willingness to work with people who 

might display and/or have mental health 

conditions.

X Willingness to refer for treating conditions

outside one’s expertise.

X Appreciation of the contribution of 

multiple disciplines to the evaluation 

process.
11

TF 1. Understanding Addiction

Bibliography

Members of the National ATTC Curriculum Committee reviewed the bibliography from the 

first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily 

textbooks are referenced in this section; however, such texts are not mutually exclusive of the 

practice dimensions.

TF I. Understanding Addiction

Akers, R.L. (1992). Drugs, Alcohol, and Society: Social Structure, Process, and Policy. 

Monterey, CA: Brooks/Cole.

Baer, J.S., Marlatt, G.A., & McMahon, R.J. (Eds.) (1993). Addictive Behaviors Across the 

Life Span. Newbury Park, CA: Sage Publications.

Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.

Blevins, G.A., Dana, R.Q., & Lewis, J.A. (1994). Substance Abuse Counseling: An Individual 

Approach (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Cohen, W.E., Holstein, M.E., & Inaba, D.S. (1997). Uppers, Downers, All Arounders: Physical 

and Mental Effects of Psychoactive Drugs (3rd ed.). Ashland, OR: CNS Publications.

Collins, R.L., Leonard, K.E., & Searles, J.S. (Eds.) (1990). Alcohol and the Family: Research 

and Clinical Perspectives. New York: Guilford Press.

Curtis, O. (1998). Chemical Dependency: A Family Affair. Pacific Grove, CA: Brooks/Cole.

Epstein, E.E., & McCrady, B.S. (Eds.) (1999). Addictions: A Comprehensive Guidebook. 

New York: Oxford University Press.

Fisher, G.L., & Harrison, T.C. (2004). Substance Abuse: Information for School Counselors, 

Social Workers, Therapists, and Counselors. Boston: Allyn & Bacon.

Gullotta, T.P., Adams, G.R., & Montemayor, R. (Eds.) (1994). Substance Misuse in Adolescence. 

Thousand Oaks, CA: Sage Publications.

Jaffe, J. (Ed.) (1995). Encyclopedia of Drugs and Alcohol. New York: Macmillan.

Jonnes, J. (1999). Hep-Cats, Narcs, and Pipe Dreams: A History of America’s Romance With 

Illegal Drugs. Baltimore: Johns Hopkins University Press.

Kinney, J. (2003). Loosening the Grip: A Handbook of Alcohol Information (7th ed.). New York: 

McGraw-Hill.

Lawson, A.W., Lawson, G.W., & Rivers, P.C. (1996). Essentials of Chemical Dependency 

Counseling (2nd ed.). Gaithersburg, MD: Aspen Publishers.

Lawson, G.W., & Lawson, A.W. (1992). Adolescent Substance Abuse: Etiology, Treatment, 

and Prevention. Gaithersburg, MD: Aspen Publishers.

Lewis, J.A., Dana, R.Q., & Blevins, G.A. (2001). Substance Abuse Counseling (3rd ed.). 

Pacific Grove, CA: Brooks/Cole.

Lowinson, J.H., Ruiz, P., et al. (Eds.) (1997). Substance Abuse: A Comprehensive Textbook

(3rd ed.). Baltimore: Lippincott Williams & Wilkins.
12

McKim, W.A. (2002). Drugs and Behavior: An Introduction to Behavioral Pharmacology

(5th ed.). Upper Saddle River, NJ: Prentice Hall.

Miller, G. (2004). Learning the Language of Addiction Counseling (2nd ed.). Hoboken, NJ: 

John Wiley & Sons.

Musto, D.F. (1999). The American Disease: Origins of Narcotic Control (3rd ed.). New York: 

Oxford University Press.

Nathan, P.E., & Gorman, J.M. (Eds.) (2002). A Guide to Treatments That Work (2nd ed.). 

New York: Oxford University Press.

Pita, D.D. (2004). Addictions Counseling: A Practical and Comprehensive Guide to Counseling 

People With Addictions. New York: Crossroad Publishing.

Rutzky, J. (1998). Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics 

and Addicts. Northvale, NJ: Jason Aronson.

Thombs, D.L. (1999). Introduction to Addictive Behaviors (2nd ed.). New York: Guilford Press.

Venturelli, P. (Ed.) (1994). Drug Use in America: Social, Cultural, and Political Perspectives. 

Boston: Jones and Bartlett Publishers.

Wallen, J. (1993). Addiction in Human Development: Developmental Perspectives on Addiction 

and Recovery. New York: Haworth Press.

White, W.L. (1998). Slaying the Dragon: The History of Addiction Treatment and Recovery in 

America. Bloomington, IL: Chestnut Health Systems.

Addiction Counseling Competencies
13

Transdisciplinary Foundation II

TREATMENT KNOWLEDGE
14
15

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

TF II. Treatment Knowledge

Competency 5:

Describe the philosophies, practices, policies, and outcomes of the most 

generally accepted and scientifically supported models of treatment, 

recovery, relapse prevention, and continuing care for addiction and other 

substance-related problems.

Knowledge

X Generally accepted models, such as 

but not limited to:

– pharmacotherapy

– mutual help and self-help

– behavioral self-control training

– mental health

– self-regulating community

– psychotherapeutic

– relapse prevention.

The philosophy, practices, policies, and 

outcomes of the most generally accepted

therapeutic models.

Alternative therapeutic models that 

demonstrate potential.

Attitudes

X Acceptance of the validity of a variety 

of approaches and models.

Openness to new, evidence-based 

treatment approaches, including 

pharmacological interventions.

Competency 6:

Recognize the importance of family, social networks, and community systems 

in the treatment and recovery process.

Knowledge

X The role of family, social networks, and 

community systems as assets or obstacles

in treatment and recovery processes.

Methods for incorporating family and

social dynamics in treatment and recovery 

processes.

Attitudes

X Appreciation for the significance and 

complementary nature of various systems 

in facilitating treatment and recovery.
16

Addiction Counseling Competencies

Competency 7:

Understand the importance of research and outcome data and their 

application in clinical practice.

Knowledge

X Research methods in the social and 

behavioral sciences.

Sources of research literature relevant to

the prevention and treatment of addiction.

Specific research on epidemiology, 

etiology, and treatment efficacy.

Benefits and limitations of research.

Attitudes

X Recognition of the importance of scientific

research to the delivery of addiction 

treatment.

Openness to new information.

Competency 8:

Understand the value of an interdisciplinary approach to addiction 

treatment.

Knowledge

X Roles and contributions of multiple 

disciplines to treatment efficacy.

Terms and concepts necessary to communicate effectively across disciplines.

The importance of communication with

other disciplines.

Attitudes

X

u

u

Desire to collaborate.

Respect for the contribution of multiple

disciplines to the recovery process.

Commitment to professionalism.
17

Bibliography

Members of the National ATTC Curriculum Committee reviewed the bibliography from the 

first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily 

textbooks are referenced in this section; however, such texts are not mutually exclusive of the 

practice dimensions.

TF II. Treatment Knowledge

Benshoff, J.J., & Janikowski, T.P. (2000). The Rehabilitation Model of Substance Abuse 

Counseling. Pacific Grove, CA: Brooks/Cole.

Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused 

Approach. New York: W.W. Norton.

Brown, S. (Ed.) (1995). Treating Alcoholism. San Francisco: Jossey-Bass.

Donigian, J., & Malnati, R. (1996). Systemic Group Therapy: A Triadic Model. Pacific Grove, CA: 

Brooks/Cole.

Greenlick, M., Lamb, S., & McCarty, D. (Eds.) (1998). Bridging the Gap Between Practice and 

Research: Forging Partnerships With Community-Based Drug and Alcohol Treatment. 

Washington, DC: National Academy Press.

Heather, N., & Miller, W.R. (Eds.) (1998). Treating Addictive Behaviors (2nd ed.). New York: 

Plenum Press.

Institute of Medicine (1990). Broadening the Base of Treatment for Alcohol Problems. 

Washington, DC: National Academy Press.

L’Abate, L., Farrar, J.L., & Serritella, D. (1991). Handbook of Differential Treatments for 

Addictions. Boston: Allyn & Bacon.

Lawson, A.W., & Lawson, G.W. (1998). Alcoholism and the Family: A Guide to Treatment and 

Prevention (2nd ed.). Gaithersburg, MD: Aspen Publishers.

Miller, W.R., & Rollnick, S. (1991). Motivational Interviewing: Preparing People To Change 

Addictive Behavior. New York: Guilford Press.

Nowinski, J. (1990). Substance Abuse in Adolescents and Young Adults: A Guide to Treatment. 

New York: W.W. Norton.

Stevens, P., & Smith, R.L. (2004). Substance Abuse Counseling: Theory and Practice (3rd ed.). 

Old Tappan, NJ: Prentice Hall.

TF II. Treatment Knowledge
18
19

Transdisciplinary Foundation III

APPLICATION TO PRACTICE
20
21

TF III. Application to Practice

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Competency 9:

Understand the established diagnostic criteria for substance use disorders, 

and describe treatment modalities and placement criteria within the 

continuum of care.

Knowledge

X Established diagnostic criteria, 

including but not limited to current 

Diagnostic and Statistical Manual of 

Mental Disorders (DSM) standards and

current International Classification of 

Diseases (ICD) standards.

X Established placement criteria developed

by various States and professional 

organizations.

X Strengths and limitations of various 

diagnostic and placement criteria.

X Continuum of treatment services and 

activities.

Attitudes

X Openness to a variety of treatment services

based on client need.

X Recognition of the value of research 

findings.

Competency 10:

Describe a variety of helping strategies for reducing the negative effects of 

substance use, abuse, and dependence.

Knowledge

X A variety of helping strategies, including 

but not limited to:

– evaluation methods and tools

– stage-appropriate interventions

– motivational interviewing 

– involvement of family and 

 significant others

– mutual-help and self-help programs

– coerced and voluntary care models

– brief and longer term interventions.

Attitudes

X Openness to various approaches to 

recovery.

X Appreciation that different approaches 

work for different people.
22

Addiction Counseling Competencies

Competency 11:

Tailor helping strategies and treatment modalities to the client’s stage of 

dependence, change, or recovery.

Knowledge

X Strategies appropriate to the various 

stages of dependence, change, 

and recovery.

Attitudes

X Flexibility in choice of treatment 

modalities.

X Respect for the client’s racial, cultural, 

economic, and sociopolitical backgrounds.

Competency 12:

Provide treatment services appropriate to the personal and cultural identity 

and language of the client.

Knowledge

X Various cultural norms, values, beliefs, 

and behaviors.

X Cultural differences in verbal and 

nonverbal communication.

X Resources to develop individualized 

treatment plans.

Attitudes

X Respect for individual differences 

within cultures.

X Respect for differences between cultures.

Competency 13:

Adapt practice to the range of treatment settings and modalities.

Knowledge

X The strengths and limitations of 

available treatment settings and 

modalities.

X How to access and make referrals to 

available treatment settings and 

modalities.

Attitudes

X Flexibility and creativity in practice 

application.
23

TF III. Application to Practice

Competency 14:

Be familiar with medical and pharmacological resources in the treatment of 

substance use disorders.

Knowledge

X Current literature regarding medical 

and pharmacological interventions.

X Assets and liabilities of medical and 

pharmacological interventions.

X Health practitioners in the community 

who are knowledgeable about addiction

and addiction treatment.

X The role that medical problems and 

complications can play in the intervention

and treatment of addiction.

Attitudes

X Open and flexible with respect to 

the potential risks and benefits of 

pharmacotherapies to the treatment 

and recovery process.

Competency 15:

Understand the variety of insurance and health maintenance options 

available and the importance of helping clients access those benefits.

Knowledge

X Existing public and private payment plans

including treatment orientation and 

coverage options.

X Methods for gaining access to available

payment plans.

 

X Policies and procedures used by available

payment plans.

X Key personnel, roles, and positions 

within plans used by the client 

population.

Attitudes

X Willingness to cooperate with 

payment providers.

X Willingness to explore treatment 

alternatives.

X Interest in promoting the most 

cost-effective, high-quality care.
24

Addiction Counseling Competencies

Competency 16:

Recognize that crisis may indicate an underlying substance use disorder and 

may be a window of opportunity for change.

Knowledge

u The features of crisis, which may 

include but are not limited to:

– family disruption

– social and legal consequences

– physical and psychological 

– panic states

– physical dysfunction.

X Substance use screening and assessment

methods.

X Prevention and intervention principles 

and methods.

X Principles of crisis case management.

X Posttraumatic stress characteristics.

X Critical incident debriefing methods.

X Available resources for assistance in the

management of crisis situations.

Attitudes

X Willingness to respond and follow through

in crisis situations.

X Willingness to consult when necessary.

Competency 17:

Understand the need for and the use of methods for measuring treatment 

outcome.

Knowledge

X Treatment outcome research literature.

X Scientific process in applied research.

X Appropriate measures of outcome.

X Methods for measuring the multiple 

variables of treatment outcome.

Attitudes

X Recognition of the importance of 

collecting and reporting on outcome data.

X Interest in integrating research findings

into ongoing treatment design.

Uses of The Competencies

The Competencies has been used in a number of different ways in Montana. It was incorporated 

into the Montana certification and oral exam process. In higher education settings at colleges and 

universities, The Competencies has been used to define behavioral expectations and objectives for 

addiction counseling courses. Clinically, it has been used to establish “employment competencies” 

for counselors working in a hospital-based setting with clients who abuse substances. These employment competencies were also modified for use by substance abuse counseling programs on the 

Crow Indian Reservation and the Rocky Boy Indian Reservation.
25

TF III. Application to Practice

Bibliography

Members of the National ATTC Curriculum Committee reviewed the bibliography from the 

first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily 

textbooks are referenced in this section; however, such texts are not mutually exclusive of the 

practice dimensions.

TF III. Application to Practice

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental 

Disorders (4th ed.). Washington, DC: American Psychiatric Association.

Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.

Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused 

Approach. New York: W.W. Norton.

Brown, S. (Ed.) (1995). Treating Alcoholism. San Francisco: Jossey-Bass.

Cavanaugh, E.R., Ginzburg, H.M., et al. (1989). Drug Abuse Treatment: A National Study of 

Effectiveness. Chapel Hill, NC: University of North Carolina Press.

Chiauzzi, E.J. (1991). Preventing Relapse in the Addictions: A Biopsychosocial Approach. 

New York: Pergamon.

Deitch, D., & Solit, R. (1993). Training of drug abuse treatment personnel in therapeutic 

community methodology. Psychotherapy, 30(2):305-316.

Donigian, J., & Malnati, R. (1997). Systemic Group Therapy: A Triadic Model. Pacific Cove, CA: 

Brooks/Cole.

Ettore, E. (1992). Women and Substance Use. New Brunswick, NJ: Rutgers University Press.

Evans, K., & Sullivan, J.M. (2001). Dual Diagnosis: Counseling the Mentally Ill Substance 

Abuser (2nd ed.). New York: Guilford Press.

Flores, P.J. (1997). Group Psychotherapy With Addicted Populations: An Integration of 

Twelve-Step and Psychodynamic Theory (2nd ed.). New York: Haworth Press.

Galanter, M. (1993). Network Therapy for Alcohol and Drug Abuse. New York: Guilford Press.

Institute of Medicine (1990). Treating Drug Problems, Volume 1: The Report. Washington, DC: 

National Academy Press.

Levin, J.D. (1995). Introduction to Alcoholism Counseling: A Bio-Psycho-Social Approach

(2nd ed.). New York: Taylor & Francis.

Lewis, J.A. (Ed.) (1994). Addictions: Concepts and Strategies for Treatment. Gaithersburg, MD: 

Aspen Publishers.

McCrady, B.S., & Miller, W.R. (Eds.) (1993). Research on Alcoholics Anonymous: 

Opportunities and Alternatives. New Brunswick, NJ: Rutgers Center of Alcohol Studies.

McLellan, A.T., Woody, G.E., et al. (1988). Is the counselor an “active ingredient” in substance 

abuse rehabilitation? An examination of treatment success among four counselors. 

Journal of Nervous and Mental Disease, 176:430-432.
26

Meyers, R.J., & Smith, J.E. (1995). Clinical Guide to Alcohol Treatment: The Community 

Reinforcement Approach. New York: Guilford Press.

Miller, N.S., Gold, M.S., & Smith, D.E. (Eds.) (1997). Manual of Therapeutics for Addictions. 

New York: Wiley-Liss.

Miller, W.R., & Heather, N. (Eds.) (1998). Treating Addictive Behaviors: Processes of Change 

(2nd ed.). New York: Plenum Press. 

Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990). Alcoholism Treatment: Context, Process, 

and Outcome. New York: Oxford University Press.

Murphy, L.L., & Impara, J.C. (Eds.) (1996). Buros Desk Reference: Assessment of Substance 

Abuse. Lincoln, NE: Buros Institute of Mental Measurements.

Najavits, L.M., & Weiss, R.D. (1994). Variations in therapist effectiveness in the treatment of 

patients with substance use disorder: An empirical review. Addictions, 89:679-688.

Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: 

Applications to addictive behaviors. American Psychologist, 47:1102-1114.

Rutzky, J. (1998). Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics 

and Addicts. Northvale, NJ: Jason Aronson.

Vannicelli, M. (1992). Removing the Roadblocks: Group Psychotherapy With Substance Abusers 

and Family Members. New York: Guilford Press.

Washton, A.M. (1995). Psychotherapy and Substance Abuse: A Practitioner’s Handbook. 

New York: Guilford Press.

Zweben, J.E. (Ed.) (1990). Understanding and preventing relapse. Journal of Psychoactive 

Drugs, 22(2).

Addiction Counseling Competencies
27

Transdisciplinary Foundation

IV

PROFESSIONAL READINESS
28
29

TF IV. Professional Readiness

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Competency 18:

Understand diverse cultures, and incorporate the relevant needs of culturally 

diverse groups, as well as people with disabilities, into clinical practice.

Knowledge

X Information and resources regarding 

racial and ethnic cultures, lifestyles, 

gender, and age as well as relevant needs

of people with disabilities.

X The unique influence the client’s culture,

lifestyle, gender, and other relevant factors

may have on behavior.

X The relationship between substance use

and diverse cultures, values, and lifestyles.

X Assessment and intervention methods that

are appropriate to culture and gender.

X Counseling methods relevant to the needs

of culturally diverse groups and people

with disabilities.

X The Americans with Disabilities Act and

other legislation related to human, civil,

and clients’ rights.

Attitudes

X Willingness to explore and identify one’s

own cultural values.

X Acceptance of other cultural values as valid

for other individuals.

Competency 19:

Understand the importance of self-awareness in one’s personal, professional, 

and cultural life.

Knowledge

X Personal and professional strengths 

and limitations.

X Cultural, ethnic, or gender biases.

Attitudes

X Openness to constructive supervision.

X Willingness to grow and change personally

and professionally.
30

Addiction Counseling Competencies

Competency 20:

Understand the addiction professional’s obligations to adhere to ethical and 

behavioral standards of conduct in the helping relationship.

Knowledge

X The features of crisis, which may include

but are not limited to:

– family disruption

– social and legal consequences

– physical and psychological 

panic states

– physical dysfunction.

X Substance use screening and assessment

methods.

X Intervention principles and methods.

X Principles of crisis case management.

X Posttraumatic stress characteristics.

X Critical incident debriefing methods.

X Available resources for assistance in the

management of crisis situations.

Attitudes

X Willingness to conduct oneself in 

accordance with the highest ethical 

standards.

X Willingness to comply with regulatory and

 professional expectations.

Competency 21:

Understand the importance of ongoing supervision and continuing education in the delivery of client services.

Knowledge

X Benefits of self-assessment and clinical

supervision to professional growth and

development.

X The value of consultation to enhance 

personal and professional growth.

X Resources available for continuing 

education.

X Supervision principles and methods.

Attitudes

X Commitment to continuing professional

education.

X Willingness to engage in a supervisory

relationship.
31

TF IV. Professional Readiness

Competency 22:

Understand the obligation of the addiction professional to participate in 

prevention and treatment activities.

Knowledge

X Research-based prevention models and

strategies.

X The relationship between prevention and

treatment.

X Environmental strategies and prevention

campaigns.

X Benefits of working with community 

coalitions.

Attitudes

X Appreciation of the inherent value of 

prevention.

X Openness to research-based prevention

strategies.

Competency 23:

Understand and apply setting-specific policies and procedures for handling 

crisis or dangerous situations, including safety measures for clients and staff.

Knowledge

X Setting-specific policies and procedures.

X What constitutes a crisis or danger to the

client and/or others.

X The range of appropriate responses to a

crisis or dangerous situation.

X Universal precautions.

X Legal implications of crisis response.

X Exceptions to confidentiality rules in crisis

or dangerous situations.

Attitudes

X Understanding of the potential seriousness

of crisis situations.

X Awareness for the need for caution and

self-control in the face of crisis or danger.

X Willingness to request help in potentially

dangerous situations.

Uses of The Competencies

The Board of Directors of the Illinois Alcohol and Other Drug Abuse Professional Certification 

Association has endorsed and will be incorporating the knowledge, skills, and attitudes provided 

in The Competencies into all of its models for Certified Alcohol and Other Drug Abuse Counselors. 

The 22 training programs in Illinois that will be implementing these models are supportive of 

this change.

A recently developed certificate for people who are employed in support positions for alcohol and 

drug abuse treatment programs is based on The Competencies. This credential completes a career 

path for alcohol and drug abuse treatment professionals in Illinois that will take them from support 

staff to master’s level.
32

Addiction Counseling Competencies

Bibliography

Members of the National ATTC Curriculum Committee reviewed the bibliography from the 

first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily 

textbooks are referenced in this section; however, such texts are not mutually exclusive of the 

practice dimensions.

TF IV. Professional Readiness

Atkinson, D.R., Morten, G., & Sue, D.W. (1997). Counseling American Minorities. New York: 

McGraw-Hill.

Bell, P. (2002). Chemical Dependency and the African American: Counseling and Prevention 

Strategies (2nd ed.). Center City, MN: Hazelden.

Bepko, C. (Ed.) (1992). Feminism and Addiction. New York: Haworth Press.

Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused 

Approach. New York: W.W. Norton.

Bissell, L., & Royce, J.E. (1994). Ethics for Addiction Professionals (2nd ed.). Center City, MN: 

Hazelden.

Cushner, K., & Brislin, R.W. (1997). Improving Intercultural Interactions—Modules for 

Cross-Cultural Training Programs. Thousand Oaks, CA: Sage Publications.

Delgado, M. (Ed.) (1998). Alcohol Use/Abuse Among Latinos: Issues and Examples of Culturally 

Competent Services. New York: Haworth Press.

Delgado, M., Segal, B., & Lopex, R. (Eds.) (1999). Conducting Drug Abuse Research With 

Minority Populations: Advances and Issues. New York: Haworth Press.

Ettore, E. (1992). Women and Substance Use. New Brunswick, NJ: Rutgers University Press.

Feld, B.C. (1999). Bad Kids: Race and the Transformation of the Juvenile Court. New York: 

Oxford University Press.

Gardenswartz, L., & Rowe, A. (1994). The Managing Diversity Survival Guide: A Complete 

Collection of Checklists, Activities, and Tips (book and disk). Chicago: Irwin Professional 

Publishing.

Gomberg, E.S.L., & Nirenberg, T.D. (Eds.) (1993). Women and Substance Abuse. Norwood, NJ: 

Ablex Publishing.

Gordon, J.U. (Ed.) (1994). Managing Multiculturalism in Substance Abuse Services. Thousand 

Oaks, CA: Sage Publications.

Hawkins, J.D., & Catalano, R.F. (1992). Communities That Care: Action for Drug Abuse 

Prevention. San Francisco: Jossey-Bass.

Heinemann, A. (Ed.) (1993). Substance Abuse and Physical Disability. New York: 

Haworth Press.

Herring, R.D. (1999). Counseling Native American Indians and Alaska Natives: Strategies for 

Helping Professionals. Thousand Oaks, CA: Sage Publications.

Hogan, J.A., Gabrielson, K.R., et al. (2003). Substance Abuse Prevention: The Intersection of 

Science and Practice. Boston: Allyn & Bacon.
33

TF IV. Professional Readiness

Imhof, J. (1991). Countertransference issues in alcoholism and drug addiction. Psychiatric 

Annals, 21:292-306.

Ivey, A.E., Simek-Morgan, L., et al. (2001). Theories of Counseling and Psychotherapy: 

A Multicultural Perspective (5th ed.). Boston: Allyn & Bacon.

Ja, D., & Aoki, B. (1993). Substance abuse treatment: Cultural barriers in the Asian-American 

community. Journal of Psychoactive Drugs, 25(1):61-71.

Jandt, F.E. (Ed.) (2003). Intercultural Communication: A Global Reader. Thousand Oaks, CA: 

Sage Publications.

Lipton, H., & Lee, P. (1998). Drugs and the Elderly: Clinical, Social, and Policy Perspectives. 

Stanford, CA: Stanford University Press.

Lowinson, J.H., Ruiz, P., et al. (Eds.) (1997). Substance Abuse: A Comprehensive Textbook 

(3rd ed.). Baltimore: Lippincott Williams & Wilkins.

Maracle, B. (1994). Crazywater: Native Voices on Addiction and Recovery. New York: 

Penguin Books.

Miller, G. (2004). Learning the Language of Addiction Counseling (2nd ed.). Hoboken, NJ: 

John Wiley & Sons.

Pagani-Tousignant, C. (1992). Breaking the Rules: Counseling Ethnic Minorities. 

Minneapolis, MN: Johnson Institute.

Paniagua, F.A. (2005). Assessing and Treating Culturally Diverse Clients: A Practical Guide

(3rd ed.). Thousand Oaks, CA: Sage Publications.

Paul, J.P., Stall, R., & Bloomfield, K.A. (1991). Gay and alcoholic: Epidemiologic and clinical 

issues. Alcohol Health and Research World, 15:151-160.

Pedersen, P.B. (1997). Culture-Centered Counseling Interventions: Striving for Accuracy. 

Thousand Oaks, CA: Sage Publications.

Pedersen, P.B. (1997). Decisional Dialogues in a Cultural Context: Structured Exercises. 

Thousand Oaks, CA: Sage Publications.

Pedersen, P.B., Draguns, J.G., et al. (Eds.) (2002). Counseling Across Cultures (5th ed.). 

Thousand Oaks: Sage Publications.

Perkinson, R.R. (1997). Chemical Dependency Counseling: A Practical Guide. Thousand Oaks, 

CA: Sage Publications.

Pope-Davis, D.B., & Coleman, H.L.K. (1997). Multicultural Counseling Competencies, 

Assessment, Education and Training, and Supervision. Thousand Oaks, CA: Sage 

Publications.

Singelis, T.M. (Ed.) (1998). Teaching About Culture, Ethnicity, and Diversity: Exercises and 

Planned Activities. Thousand Oaks, CA: Sage Publications. 

Storti, S.A. (1997). Alcohol, Disabilities, and Rehabilitation. San Diego, CA: Singular 

Publishing Group.

Sue, D.W., & Sue, D. (2002). Counseling the Culturally Different: Theory and Practice (4th ed.). 

New York: John Wiley & Sons.
34

Addiction Counseling Competencies

Trimble, J.E., Bolek, C.S., & Niemcryk, S.J. (Eds.) (1992). Ethnic and Multicultural Drug Abuse: 

Perspectives on Current Research. New York: Harrington Park Press.

Weinstein, D.L. (Ed.) (1993). Lesbians and Gay Men: Chemical Dependency Treatment Issues. 

New York: Haworth Press.

Williams, R., & Gorski, T.T. (1997). Relapse Prevention Counseling for African Americans: 

A Culturally Specific Model. Independence, MO: Herald House/Independence Press.

Williams, R., & Gorski, T.T. (1997). Relapse Warning Signs for African Americans: A Culturally 

Specific Model. Independence, MO: Herald House/Independence Press.
35

Section 2:

Introduction to the Practice Dimensions

The Practice Dimensions

Professional practice for addiction counselors is based on eight practice 

dimensions, each of which is necessary for effective performance of the 

counseling role. Several of the practice dimensions are subdivided into elements. The dimensions identified, along with the competencies that support them, form the heart of this section of The Competencies.

The Eight Practice Dimensions of

Addiction Counseling

I. Clinical Evaluation

 – Screening

 – Assessment

II. Treatment Planning

III. Referral

IV. Service Coordination

 – Implementing the Treatment Plan

 – Consulting

 – Continuing Assessment and Treatment Planning

V. Counseling

 – Individual Counseling

 – Group Counseling

 – Counseling Families, Couples, and Significant Others

VI. Client, Family, and Community Education

VII. Documentation

VIII. Professional and Ethical Responsibilities

A counselor’s success in carrying out a practice dimension depends on his 

or her ability to attain the competencies underlying that component. Each 

competency, in turn, depends on its own set of knowledge, skills, and attitudes. For an addiction counselor to be truly effective, he or she should 

possess the knowledge, skills, and attitudes associated with each competency that are consistent with the counselor’s training and professional 

responsibilities.
36
37

Prac

tice

Dimension

I

CLINICAL EVALUATION
38
39

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

PD I. Clinical Evaluation

Elements:

uXX

uX

Screening

Assessment

Definition: The systematic approach to screening and assessment of individuals thought to 

have a substance use disorder, being considered for admission to addiction-related services, 

or presenting in a crisis situation.

Element: Screening

Screening is the process by which the counselor, the client, and available significant others 

review the current situation, symptoms, and other available information to determine the most 

appropriate initial course of action, given the client’s needs and characteristics and the available 

resources within the community.

Knowledge

X Importance and purpose of rapport 

building.

Rapport-building methods and issues.

The range of human emotions and 

feelings.

What constitutes a crisis.

Steps in crisis prevention and 

management.

Situations and conditions for which 

additional professional assistance may 

be necessary.

Available sources of assistance.

Skills

X Demonstrating effective verbal and 

nonverbal communication in establishing

rapport.

Accurately identifying the client’s beliefs

and frame of reference.

Reflecting the client’s feelings and 

message.

Recognizing and defusing volatile or 

dangerous situations.

Demonstrating empathy, respect, 

and genuineness.

Attitudes

X Recognition of personal biases, values, 

and beliefs and their effect on communication and the treatment process.

Willingness to establish rapport.

Competency 24:

Establish rapport, including management of a crisis situation and determination of need for additional professional assistance.
40

Addiction Counseling Competencies

Competency 25:

Gather data systematically from the client and other available collateral 

sources, using screening instruments and other methods that are sensitive 

to age, developmental level, culture, and gender. At a minimum, data 

should include current and historic substance use; health, mental health, 

and substance-related treatment histories; mental and functional statuses; 

and current social, environmental, and/or economic constraints.

Knowledge

X Validated screening instruments for 

substance use and mental status, 

including their purpose, application, 

and limitations.

Concepts of reliability and validity as they

apply to screening instruments.

How to interpret the results of screening.

How to gather and use information from

collateral sources.

How age, developmental level, culture,

and gender affect patterns and history of

use.

How age, developmental level, culture,

and gender affect communication.

Client mental status—presenting features

and relationship to substance use 

disorders and psychiatric conditions.

How to apply confidentiality rules and

regulations.

Skills

X Administering and scoring screening 

instruments.

Screening for physical and mental health

status.

Facilitating information sharing and data

collection from a variety of sources.

Communicating effectively in emotionally

charged situations.

Writing accurately, concisely, and legibly.

Attitudes

X Appreciation of the value of the datagathering process.

Uses of The Competencies

In Nebraska, The Competencies is used as a resource for instructors teaching core classes preparing students for State certification. It also is used as supplemental reading for students in these 

courses and other continuing education programs sponsored by the Prairielands ATTC.
41

PD I. Clinical Evaluation

Competency 26:

Screen for psychoactive substance toxicity, intoxication, and withdrawal 

symptoms; aggression or danger to others; potential for self-inflicted harm or 

suicide; and co-occurring mental disorders.

Knowledge

X Symptoms of intoxication, withdrawal, 

and toxicity for all psychoactive 

substances, alone and in interaction with

one another.

Physical, pharmacological, and 

psychological implications of psychoactive

substance use.

Effects of chronic psychoactive substance

use or intoxication on cognitive abilities.

Available resources for help with drug 

reactions, withdrawal, and violent 

behavior.

When to refer for toxicity screening or 

additional professional help.

Basic concepts of toxicity screening 

options, limitations, and legal 

implications.

Toxicology reporting language and the

meaning of toxicology reports.

Relationship between psychoactive 

substance use and violence.

Basic diagnostic criteria for suicide risk,

danger to others, withdrawal syndromes, 

and major psychiatric conditions.

Mental and physical conditions that mimic

drug intoxication, toxicity, and withdrawal.

Legal requirements concerning suicide 

and violence potential and mandatory 

reporting for abuse and neglect.

Skills

X Eliciting pertinent information from the

client and relevant others.

Intervening appropriately with a client

who may be intoxicated.

Assessing suicide and/or violence potential

using an approved risk-assessment tool.

Assessing risks of abuse and neglect of 

children and others.

Preventing and managing crises in 

collaboration with health, mental health,

and public safety professionals.

Attitudes

X Willingness to be respectful toward the 

client in his or her presenting state.

Appreciation of the importance of empathy

in the face of feelings of anger, 

hopelessness, or suicidal or violent

thoughts and feelings.

Appreciation of the importance of legal

and administrative obligations.
42

Knowledge

X The progression and characteristics of 

substance use disorders.

The effects of psychoactive substances on 

behavior, thinking, feelings, health status, 

and relationships.

Denial and other defense mechanisms in 

client resistance.

Skills

X Establishing a therapeutic relationship.

Demonstrating effective communication 

and interviewing skills.

Determining and confirming with the 

client the effects of substance use on life 

problems.

Assessing client readiness to address substance use issues.

Interpreting the client’s perception of his 

or her experiences.

Attitudes

X Respect for the client’s perception of his 

or her experiences.

Addiction Counseling Competencies

Competency 27:

Assist the client in identifying the effect of substance use on his or her current life problems and the effects of continued harmful use or abuse.

Competency 28:

Determine the client’s readiness for treatment and change as well as the 

needs of others involved in the current situation.

Knowledge

X Current validated instruments for 

assessing readiness to change.

Treatment options.

Stages of readiness.

Stages-of-change models.

The role of family and significant others 

in supporting or hindering change.

Skills

X Assessing client readiness for treatment.

Assessing extrinsic and intrinsic 

motivators.

Assessing the needs of family members 

including children for appropriate levels 

of care and providing support; 

recommending followup services.

Attitudes

X Acceptance of nonreadiness as a stage 

of change.

Appreciation that motivation is not a 

prerequisite for treatment.

Recognition of the importance of the client’s self-assessment.
43

PD I. Clinical Evaluation

Competency 29:

Review the treatment options that are appropriate for the client’s needs, 

characteristics, goals, and financial resources.

Knowledge

X Treatment options and their philosophies 

and characteristics.

Relationship among client needs, available 

treatment options, and other community 

resources.

Skills

X Eliciting and determining relevant client 

characteristics, needs, and goals.

Making appropriate recommendations 

for treatment and use of other available 

community resources.

Collaborating with the client to determine 

the best course of action.

Attitudes

X Recognition of one’s own treatment biases.

Appreciation of various treatment 

approaches.

Willingness to link client with a variety 

of helping resources.

Competency 30:

Apply accepted criteria for diagnosis of substance use disorders in making 

treatment recommendations.

Knowledge

X The continuum of care and the available 

range of treatment modalities.

Current Diagnostic and Statistical 

Manual of Mental Disorders (DSM) or 

other accepted criteria for substance use 

disorders, including strengths and 

limitations of such criteria.

Use of commonly accepted criteria for

client placement into levels of care.

Multiaxis diagnostic criteria.

Skills

X Using current DSM or other accepted 

diagnostic standards.

Using appropriate placement criteria.

Obtaining information necessary to 

develop a diagnostic impression.

Attitudes

X Recognition of personal and professional 

limitations of practice, based on 

knowledge and training.

Willingness to base treatment 

recommendations on the client’s best 

interest and preferences.
44

Knowledge

X Admission and referral protocols.

Resources for referral.

Ethical standards regarding referrals.

Appropriate documentation.

How to apply confidentiality rules and 

regulations.

Clients’ rights to privacy.

Skills

X Communicating clearly and appropriately.

Networking and advocating with service 

providers.

Negotiating and advocating client admissions to appropriate treatment resources.

Facilitating client followthrough.

Documenting accurately and appropriately.

Attitudes

X Willingness to renegotiate.

Addiction Counseling Competencies

Competency 31:

Construct with the client and appropriate others an initial action plan based 

on client needs, client preferences, and resources available.

Knowledge

X Appropriate content and format of the 

initial action plan.

The client’s needs and preferences.

Available resources for admission or 

referral.

Skills

X Developing the action plan in collaboration with the client and appropriate 

others.

Documenting the action plan.

Contracting with the client concerning 

the initial action plan.

Attitudes

X Willingness to work collaboratively with 

the client and others.

Uses of The Competencies

The Office of Alcoholism and Substance Abuse Services uses the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc.’s examination for Alcohol and Other Drug 

Abuse Counselors as the standard of minimum competence for counselors seeking a credential in 

New York State. This examination is based on the 12 Core Functions of alcoholism and substance 

abuse counselors, which are consistent with the practice dimensions and competencies outlined in 

The Competencies.

Competency 32:

Based on the initial action plan, take specific steps to initiate an admission or 

referral and ensure followthrough.
45

PD I. Clinical Evaluation

Uses of The Competencies

The Competencies is being used in a series of scale validation studies by Alicia Wendler of the 

Mid-America ATTC and Tamera Murdock and Johanna Nilsson of the University of Missouri–Kansas 

City to develop the Addiction Counseling Self-Efficacy Scale (ACSES). The 32-item ACSES assesses 

addiction counselors’ perceptions of their self-efficacy for addiction counseling skills and includes 

five subscales: 

uXX Executing specific addiction counseling skills

u Assessment, treatment planning, and referral skills

u Working with various co-occurring mental disorders

u Group counseling skills

u Basic counseling microskills.

The researchers reported adequate internal consistency of the scale with a sample of 451 addiction 

counselors. Preliminary validity evidence for the scale was determined through two exploratory 

factor analyses, and the scale was found to be sensitive to counselor experience and degree levels.
46

Competency 33:

Select and use a comprehensive assessment process that is sensitive to age, 

gender, racial and ethnic culture, and disabilities that includes but is not 

limited to:

u History of alcohol and drug use

u Physical health, mental health, and addiction treatment histories

u Family issues

u Work history and career issues

u History of criminality

u Psychological, emotional, and worldview concerns

u Current status of physical health, mental health, and substance use

u Spiritual concerns of the client

u Education and basic life skills

u Socioeconomic characteristics, lifestyle, and current legal status

u Use of community resources

u Treatment readiness

u Level of cognitive and behavioral functioning.

Knowledge

X Basic concepts of test validity and 

reliability.

X Current validated assessment instruments 

and protocols.

X Appropriate use and limitations of 

standardized instruments.

X The range of life areas to be assessed in a 

comprehensive assessment.

X How age, developmental level, cognitive 

and behavioral functioning, racial and 

ethnic culture, gender, and disabilities 

can influence the validity and appropriateness of assessment instruments and 

interview protocols.

Skills

X Selecting and administering appropriate 

assessment instruments and protocols 

within the counselor’s scope of practice.

X Introducing and explaining the purpose of 

assessment.

X Addressing client perceptions and providing appropriate explanations of issues 

being discussed.

X Conducting comprehensive assessment 

interviews and collecting information from 

collateral sources.

Attitudes

X Respect for the limits of assessment 

instruments and one’s ability to 

interpret them.

X Willingness to refer for additional 

specialized assessment.

Addiction Counseling Competencies

Element: Assessment

Assessment is an ongoing process through which the counselor collaborates with the client and 

others to gather and interpret information necessary for planning treatment and evaluating 

client progress.
47

Knowledge

X The counselor’s role, responsibilities, 

and scope of practice.

The limits of the counselor’s training and 

education.

The supervisor’s role and how supervision 

can contribute to quality assurance and 

improvement of clinical skills.

Available consultation services and roles 

of consultants.

The multidisciplinary assessment 

approach.

Skills

X Recognizing the need for review by or 

assistance from a supervisor.

Recognizing when consultation is 

appropriate.

Providing appropriate documentation.

Communicating oral and written 

information clearly.

Incorporating information from supervision and consultation into assessment 

findings.

Attitudes

X Commitment to professionalism.

Acceptance of one’s own personal and 

professional limitations.

Willingness to continue learning and 

improving clinical skills.

PD I. Clinical Evaluation

Knowledge

X Appropriate scoring methodology for 

assessment instruments.

How to analyze and interpret assessment 

results.

The range of available treatment options.

Skills

X Scoring assessment tools.

Interpreting data relevant to the client.

Using results to identify client needs and 

appropriate treatment options.

Communicating recommendations to the 

client and appropriate service providers.

Attitudes

X Respect for the value of assessment in determining appropriate treatment plans.

Competency 34:

Analyze and interpret the data to determine treatment recommendations.

Competency 35:

Seek appropriate supervision and consultation.
48

Addiction Counseling Competencies

Knowledge

X Agency-specific protocols and procedures.

Appropriate terminology and 

abbreviations.

Legal implications of actions and 

documentation.

How to apply confidentiality rules and 

regulations and clients’ rights to privacy.

Skills

X Providing clear, concise, and legible 

documentation.

Incorporating information from various 

sources.

Preparing and clearly presenting, in oral 

and written form, assessment findings to 

the client and other professionals within 

the bounds of confidentiality rules and 

regulations.

Attitudes

X Recognition of the value of accurate 

documentation.

Competency 36:

Document assessment findings and treatment recommendations.

Uses of The Competencies

The Competencies has been used as a training standard for the Licensed Chemical Dependency 

Counselor credential in Texas. The competencies were infused not only into academic course work, 

but also into three levels of supervised work experience. A companion evaluation tool was 

developed to monitor mastery of the competencies.

In addition, a number of colleges and universities across Texas have infused the knowledge, skills, 

and attitudes from The Competencies into their addiction counseling coursework and curricula. 

Many have changed course descriptions, learning outcomes, and course objectives.
49

PD I. Clinical Evaluation

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Addiction Counseling Competencies
53

Prac

tice

Dimension II

TREATMENT PLANNING
54
55

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

PD II. Treatment Planning

Definition: A collaborative process in which professionals and the client develop a written 

document that identifies important treatment goals; describes measurable, time-sensitive 

action steps toward achieving those goals with expected outcomes; and reflects a verbal 

agreement between a counselor and client. 

At a minimum an individualized treatment plan addresses the identified substance use 

disorder(s), as well as issues related to treatment progress, including relationships with 

family and significant others, potential mental conditions, employment, education, 

spirituality, health concerns, and social and legal needs.

Knowledge

X The role assessment plays in identifying 

client problems, resources, and barriers 

to treatment.

Stages of change and readiness for 

treatment.

The impact that the client and family 

systems have on treatment decisions and 

outcomes.

Other sources of assessment information.

Skills

X Establishing treatment priorities based on 

all available assessment data.

Interpreting assessment information considering the client’s age, developmental 

level, treatment readiness, gender, and 

racial and ethnic culture.

Using assessment information to individualize the client’s treatment goals.

Attitudes

X Appreciation of the strengths and limitations of the assessment data.

Recognition that assessment is an ongoing 

process throughout treatment.

Competency 37:

Use relevant assessment information to guide the treatment planning 

process.
56

Addiction Counseling Competencies

Knowledge

X How to apply confidentiality rules and 

regulations.

How to communicate assessment data in 

understandable terms.

Factors affecting the client’s 

comprehension of assessment data.

Roles and expectations of significant 

others involved in treatment.

Skills

X Summarizing and synthesizing assessment 

results.

Translating assessment information into 

treatment goals and objectives.

Evaluating the client’s comprehension of 

assessment feedback.

Communicating with the client in a manner that is sensitive to the client’s age, developmental level, gender, and racial and 

ethnic culture.

Communicating assessment findings to 

interested parties within the bounds of 

confidentiality rules and regulations and 

practice standards.

Attitudes

X Recognition of how biases influence communication of assessment data and results.

Recognition of the client’s right and need 

to understand assessment results.

Respect for the roles of others.

Competency 38:

Explain assessment findings to the client and significant others.

Uses of The Competencies

The Caribbean Basin and Hispanic (CBH) ATTC in Puerto Rico has translated The Competencies

into Spanish and has widely distributed it in Puerto Rico and the mainland. (The translation is posted on the CBHATTC Web site, http://www.attcnetwork.org/regcenters/index_caribbeanbasin.asp.)

The curriculum of the Substance Abuse Graduate Program of the Universidad Central del Caribe was 

based on The Competencies.

The Competencies has been used as a resource for trainers teaching workshops such as Clinical 

Skills in Supervision, S.M.A.R.T., Treatment Planning, and Levels of Care in Substance Abuse.

Some community-based organizations have incorporated The Competencies into their inservice 

trainings.

The Comisión Certificadora de Profesionales en Substancias Sicoactivas of Puerto Rico (certification 

board) incorporated The Competencies into its certifications standards.

The Puerto Rico Drug Control Office used The Competencies to develop the Addiction Prevention 

Specialist Licensure standards in Puerto Rico.
57

PD II. Treatment Planning

Knowledge

X Verbal and nonverbal communication 

styles.

Methods to elicit feedback from the client 

and significant others.

Skills

X Eliciting and integrating feedback during 

the planning process.

Working collaboratively with the client and 

significant others.

Establishing a trusting relationship with 

the client and significant others. 

Attitudes

X Willingness to communicate interactively 

with the client and significant others.

Openness to client questions and input.

Competency 39:

Provide the client and significant others with clarification and additional 

information as needed.

Knowledge

X Treatment interventions, client placement 

criteria, and outside referral options.

Current research findings on various 

treatment models. 

Alternatives to treatment, including no 

treatment.

Skills

X Presenting the range of treatment options 

and settings available.

Using assessment data to make treatment 

recommendations.

Considering the client’s needs and preferences when selecting treatment settings.

Using the treatment planning process to 

foster collaborative relationships with the 

client and significant others.

Attitudes

X Willingness to negotiate treatment options 

with the client.

Openness to a variety of approaches.

Respect for the input of the client and 

significant others.

Competency 40:

Examine treatment options in collaboration with the client and significant 

others.
58

Addiction Counseling Competencies

Knowledge

X Stages-of-change process. 

Methods of tailoring treatment strategies 

to match the client’s motivational level. 

Skills

X Assessing the client’s stage of change.

Developing strategies to address 

ambivalence.

Eliciting the client’s preferences.

Promoting the client’s readiness to engage 

in treatment.

Attitudes

X Respect for the client’s values, goals, and 

readiness to change.

Recognition and acceptance of behavioral 

change as a multistep process. 

Competency 41:

Consider the readiness of the client and significant others to participate 

in treatment.

Knowledge

X Treatment sequencing and the continuum 

of care.

Hierarchy-of-needs models.

Holistic view of the client’s biological, 

psychological, social, and spiritual needs 

and resources. 

Skills

X Accessing referral resources necessary to 

address the client’s needs. 

Using clinical judgment in prioritizing 

client problems. 

Assessing severity of client problems and 

prioritizing appropriately.

Attitudes

X Recognition and acceptance of the client as 

an active participant in prioritizing needs. 

Willingness to make referrals to address 

the client’s needs.

Competency 42:

Prioritize the client’s needs in the order they will be addressed in treatment.
59

PD II. Treatment Planning

Knowledge

X Use of goals and objectives to 

individualize treatment planning. 

Treatment needs of diverse populations.

How to write specific and measurable 

goal and objective statements.

Skills

X Translating assessment information into 

measurable treatment goal and objective 

statements.

Collaborating with the client to develop 

specific, measurable, and realistic goals 

and objectives.

Engaging, contracting, and negotiating mutually agreeable goals with the client.

Writing goal and objective statements in 

terms understandable to the client and 

significant others. 

Attitudes

X Respect for the client’s choice of treatment 

goals.

Respect for the client’s individual pace 

toward achieving goals.

Acceptance of the client’s readiness to 

change.

Appreciation for incremental achievements 

in completing goals.

Competency 43:

Formulate mutually agreed-on and measurable treatment goals and 

objectives.

International Applications of The Competencies

International applications of The Competencies are noteworthy. It was translated for use in the 

Czech Republic, Greece, Hungary, and Slovakia. A Spanish translation has been completed. 

Committee members have provided consultation on The Competencies in American Samoa, 

Bulgaria, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, 

Poland, the Republic of the Marshall Islands, the Republic of Palau, Italy, Slovenia, and the Territory 

of Guam. The Competencies also is being considered for trainings in Thailand by a Thai delegation 

through CSAT. In addition, the Web site created for the original version of The Competencies has 

been visited by individuals from 34 countries.
60

Addiction Counseling Competencies

Knowledge

X Intervention strategies, onsite services, 

and outside referral options.

Client’s interest in various treatment 

service options.

Treatment strategies sensitive to diverse 

populations.

Skills

X Matching interventions to the client’s 

needs and resources.

Explaining strategies in terms understandable to the client and significant others.

Identifying and making referrals to outside 

resources.

Attitudes

X Recognition that client retention improves 

when services are matched to the client’s 

needs and resources. 

Appreciation for various treatment 

strategies. 

Competency 44:

Identify appropriate strategies for each treatment goal.

Knowledge

X Treatment strategies and community 

resources.

Contributions of other professionals and 

mutual- or self-help support groups.

Levels of care and existing placement 

criteria.

The importance of the client’s age, 

developmental and educational level, 

gender, and racial and ethnic culture in 

coordinating resources.

Skills

X Coordinating treatment activities and resources consistent with the client’s needs 

and preferences.

Communicating to the client and significant others the rationale behind treatment 

recommendations.

Attitudes

X Acceptance of a variety of treatment 

recommendations.

Recognition of the importance of 

coordinating treatment activities.

Competency 45:

Coordinate treatment activities and community resources in a manner 

consistent with the client’s diagnosis and existing placement criteria.
61

PD II. Treatment Planning

Competency 46:

Develop with the client a mutually acceptable treatment plan and method for 

monitoring and evaluating progress.

Knowledge

X The relationship among problem 

statements, treatment goals, objectives, 

and intervention strategies.

Short- and long-term treatment planning.

Methods for evaluating treatment 

progress.

Skills

X Individualizing treatment plans that balance strengths and resources with problems and deficits.

Negotiating and contracting a mutually 

agreeable plan.

Writing a plan using positive, jargon-free, 

and proactive terms.

Establishing criteria to evaluate progress.

Attitudes

X Sensitivity to the client’s age, 

developmental and educational level, 

gender, and racial and ethnic culture.

Appreciation for measurable criteria of 

client progress.

Willingness to negotiate a plan.
62

Knowledge

X Federal, State, and agency confidentiality 

rules and regulations, requirements, and 

policies.

Resources for legal consultation.

Skills

X Communicating the roles of various 

interested parties and support systems.

Explaining clients’ rights and 

responsibilities and applicable 

confidentiality rules and regulations.

Responding to questions and providing 

clarification as needed.

Referring to appropriate legal authority.

Attitudes

X Respect for clients’ confidentiality rights.

Commitment to professionalism.

Recognition of the importance of 

professional collaboration within the 

bounds of confidentiality.

Competency 47:

Inform the client of confidentiality rights, program procedures that safeguard 

them, and the exceptions imposed by regulations.

Addiction Counseling Competencies

Knowledge

X How to evaluate the client’s response to 

treatment.

When and how to revise the treatment 

plan.

Skills

X Assessing the client’s response to 

treatment.

Modifying the treatment plan based on 

review of the client’s response to 

treatment and/or changing circumstances.

Negotiating changes to the plan with the 

client and significant others.

Attitudes

X Recognition of the value of client input in 

revising the treatment plan.

Openness to critically examine one’s work.

Respect for the input of the client and 

significant others.

Willingness to learn from clinical supervision and modify practice accordingly.

Competency 48:

Reassess the treatment plan at regular intervals or when indicated by 

changing circumstances.
63

PD II. Treatment Planning

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Addiction Counseling Competencies
67

Practice Dimension III

REFERRAL
68
69

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PD III. Referral

Definition: The process of facilitating the client’s use of available support systems and 

community resources to meet needs identified in clinical evaluation or treatment planning.

Knowledge

X The mission, function, resources, and 

quality of services offered by such entities 

as the following:

– civic groups, community groups, 

 and neighborhood organizations

– health and allied healthcare systems

 (managed care)

– employment and vocational 

 rehabilitation services

– cultural enhancement organizations

– faith-based organizations

– governmental entities

– criminal justice systems

– child welfare agencies

– housing administrations

– childcare facilities

– crisis intervention programs

– abused persons programs

– mutual- and self-help groups

– advocacy groups

– other agencies.

Community demographics.

Community political and cultural systems.

Criteria for receiving community services, 

including fee and funding structures.

How to access community agencies and 

service providers.

State and Federal legislative mandates 

and regulations.

Confidentiality rules and regulations.

Service gaps and appropriate ways of 

advocating for new resources.

Effective communication styles.

Community resources for both affected 

children and other household members.

Skills

X Networking and communicating.

Using existing community resource directories including computer databases.

Advocating for the client.

Working with others as part of a team.

Attitudes

X Respect for interdisciplinary service 

delivery.

Respect for both the client’s needs and 

agency services.

Respect for collaboration and cooperation.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Competency 49:

Establish and maintain relationships with civic groups, agencies, other 

professionals, governmental entities, and the community at large to ensure 

appropriate referrals, identify service gaps, expand community resources, 

and help address unmet needs.
70

Addiction Counseling Competencies

Knowledge

X The needs of the client population being 

served.

How to access current information on 

the function, mission, and resources of 

community service providers.

How to access current information on 

referral criteria and accreditation status 

of community service providers.

How to access client satisfaction data 

about community service providers.

Skills

X Establishing and nurturing collaborative 

relationships with key contacts in 

community service organizations.

Interpreting and using evaluation and 

client feedback data.

Giving feedback to community resources 

regarding their service delivery.

Attitudes

X Respect for confidentiality rules and 

regulations.

Willingness to advocate on behalf of 

the client.

Competency 50:

Continuously assess and evaluate referral resources to determine their 

appropriateness.
71

PD III. Referral

Knowledge

X Client motivation and ability to initiate 

and follow through with referrals.

Factors in determining the optimal time 

to engage the client in the referral 

process.

Clinical assessment methods.

Empowerment techniques.

Crisis prevention and intervention 

methods.

Skills

X Interpreting assessment and treatment 

planning materials to determine appropriateness of client or counselor referral.

Assessing the client’s readiness to participate in the referral process.

Educating the client about appropriate 

referral processes.

Motivating the client to take responsibility 

for referral and followup.

Applying crisis prevention and intervention techniques.

Attitudes

X Respect for the client’s ability to initiate 

and follow up with referral.

Willingness to share decisionmaking 

power with the client.

Respect for the goal of positive selfdetermination.

Recognition of the counselor’s 

responsibility to engage in client 

advocacy when needed.

Competency 51:

Differentiate between situations in which it is most appropriate for the client 

to self-refer to a resource and situations requiring counselor referral.
72

Addiction Counseling Competencies

Knowledge

X Comprehensive treatment planning.

Methods of assessing the client’s progress 

toward treatment goals.

How to tailor resources to the client’s 

treatment needs.

How to access key resource persons in 

the community service provider network.

Mission, function, and resources of 

appropriate community service providers.

Referral protocols of selected service 

providers.

Logistics necessary for client access and 

followthrough with referrals.

Applicable confidentiality rules and 

regulations and protocols.

Factors to consider when determining the 

appropriate time to engage a client in the 

referral process.

Skills

X Using oral and written communication 

for successful referrals.

Using appropriate technology to access, 

collect, and forward necessary 

documentation.

Conforming to all applicable confidentiality rules and regulations and protocols.

Documenting the referral process 

accurately.

Maintaining and nurturing relationships 

with key contacts in the community.

Implementing followup activities with 

the client.

Attitudes

X Respect for the client and the client’s 

needs and privacy rights.

Respect for collaboration and cooperation.

Respect for interdisciplinary, comprehensive approaches to meet the client’s needs.

Competency 52:

Arrange referrals to other professionals, agencies, community programs, 

or appropriate resources to meet the client’s needs.

Uses of The Competencies

In New England, The Competencies serves as the foundation of the nationally recognized ATTCNew England (NE) Distance Education program. The Competencies has been an outstanding and 

essential tool used in the development and delivery of more than 220 online presentations during 

the past 8 years. Instructors use The Competencies in all ATTC-NE trainings. In addition, the ATTCNE training staff has designed a Web-based course (Core Functions of Addiction Counseling) that 

focuses entirely on The Competencies. This training has been delivered at least 10 times to participants from all sectors of the treatment field including counselors, physicians, correctional personnel, judiciary staff, those in the educational field, and government personnel. The Competencies 

continues to be a guiding force in course development, and the Web-based training is provided to 

participants from New England and other regions.

The Competencies was used in the development of a B.S. program in chemical dependency and 

addiction studies at Rhode Island College. It has been used in designing curriculum and developing 

course content.
73

PD III. Referral

Knowledge

X How treatment planning and referral 

relate to the goals of recovery.

How the client’s defenses, abilities, 

personal preferences, cultural influences, 

personal resources, presentation, 

and appearance affect referral and 

followthrough.

Comprehensive referral information and 

protocols.

Terminology and structure used in 

referral settings.

Skills

X Using language and terms the client easily 

understands.

Interpreting the treatment plan and how 

referral relates to progress.

Engaging in effective communication 

about the referral process: negotiating, 

educating, personalizing risks and benefits, 

and contracting.

Attitudes

X Awareness of personal biases toward 

referral resources.

Competency 53:

Explain in clear and specific language the necessity for and process of 

referral to increase the likelihood of client understanding and followthrough.

Knowledge

X Mission, function, and resources of the 

referral agency or professional.

Protocols and documentation necessary 

to make the referral.

Pertinent local, State, and Federal 

confidentiality rules and regulations; 

applicable clients’ rights and 

responsibilities; client consent 

procedures; and other guiding principles 

for exchange of relevant information.

Ethical standards of practice related to 

this exchange of information.

Skills

X Using oral and written communication 

for successful referrals.

Using appropriate technology to access, 

collect, and forward relevant information 

needed by the agency or professional.

Obtaining informed client consent and 

documentation needed for the exchange 

of relevant information.

Reporting relevant information accurately 

and objectively.

Attitudes

X Commitment to professionalism.

Respect for the importance of confidentiality rules and regulations and professional 

standards.

Appreciation for the need to exchange 

relevant information with other 

professionals.

Competency 54:

Exchange relevant information with the agency or professional to whom the 

referral is being made in a manner consistent with confidentiality rules and 

regulations and generally accepted professional standards of care.
74

Addiction Counseling Competencies

Knowledge

X Methods of assessing the client’s progress 

toward treatment goals.

Appropriate sources and techniques for 

evaluating referral outcomes.

Skills

X Using appropriate measurement processes 

and instruments.

Collecting objective and subjective data on 

the referral process.

Attitudes

X Appreciation for the value of the 

evaluation process.

Appreciation for the value of interagency 

collaboration.

Appreciation for the value of 

interdisciplinary referral.

Competency 55:

Evaluate the outcome of the referral.

Uses of The Competencies

In January 2001, a counselor performance assessment system was published by the Northwest 

Frontier (NF) ATTC based on The Competencies. Developed by a noted educational psychologist, 

the publication identifies a series of benchmarks that indicate a counselor’s progress toward mastery 

of each competency for the developing, proficient, and exemplary clinician. Work is underway to 

add competencies for the entry-level counselor. 

Another NFATTC publication based on The Competencies is called Proficiency Levels for Graduates 

of Academic Degree Programs. The document establishes proficiency targets for each knowledge, 

skill, and attitude included in The Competencies at the associate’s, bachelor’s, and master’s levels.

In addition, NFATTC developed a 21-hour Clinical Supervision I course and a 14-hour Clinical 

Supervision II course based on The Competencies. The courses orient supervisors to 

The Competencies, introduce methods for assessing proficiency, and teach specific strategies for 

enhancing counselor knowledge, skills, and attitudes. Recent projects in treatment agencies in 

Idaho, Oregon, and Washington have looked at infusing The Competencies into the agencies’ 

clinical supervision practices. The Competencies is used by each agency to develop specific learning plans for counselors. Idaho endorsed the NFATTC Clinical Supervision model and requires each 

treatment agency in the State system to use that model.
75

PD III. Referral

Bibliography

PD III. Referral

Humphreys, K., Wing, S., et al. (2004). Self-help organizations for alcohol and drug 

problems: Toward evidence-based practice and policy. Journal of Substance Abuse 

Treatment, 26(3):151-158, discussion 159-165.

Johnson, N.P., & Chappel, J.N. (1994). Using AA and other 12-Step programs more effectively. 

Journal of Substance Abuse Treatment, 11(2):137-142.

Lyter, S.C., & Lyter, L.L. (2000). Intervention with groups. In A.A. Abbott (Ed.) Alcohol, Tobacco, 

and Other Drugs: Challenging Myths, Assessing Theories, Individualizing Interventions. 

Washington, DC: National Association of Social Workers Press, 247-304.

McCaughrin, W.C., & Price, R.H. (1992). Effective outpatient drug treatment organizations: 

Program features and selection effects. International Journal of the Addictions, 

27:1335-1358.

Moos, R.H., & Moos, B.S. (2004). Help-seeking careers: Connections between participation 

in professional treatment and Alcoholics Anonymous. Journal of Substance Abuse 

Treatment, 26(3):167.

Morehouse, E.R. (2000). Matching services and the needs of children of alcoholic parents: 

A spectrum of help. In S. Abbott (Ed.) Children of Alcoholics: Selected Readings, Volume II. 

Rockville, MD: National Association for Children of Alcoholics, 95-117.

Riordan, R.J., & Walsh, L. (1994). Guidelines for professional referral to Alcoholics Anonymous 

and other twelve step groups. Journal of Counseling & Development, 72:351-355.

Spencer, J.W. (1993). Making “suitable referrals”: Social workers’ construction and use of 

informal referral networks. Sociological Perspectives, 36(3):271-285.
76
77

Prac

tice

Dimension

IV

SERVICE COORDINATION
78
79

PD IV. Service Coordination

Elements:

uXX

uXX

uXX

Implementing the Treatment Plan 

Consulting

Continuing Assessment and Treatment Planning

Definition: The administrative, clinical, and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs 

identified in the treatment plan.

Service coordination, which includes case management and client advocacy, establishes a 

framework of action to enable the client to achieve specified goals. It involves collaboration 

with the client and significant others, coordination of treatment and referral services, liaison 

activities with community resources and managed care systems, client advocacy, and ongoing 

evaluation of treatment progress and client needs.

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
80

Addiction Counseling Competencies

Knowledge

X How to access and transmit information 

necessary for referral.

X Missions, functions, and resources of the 

community service network.

X Managed care and other systems affecting 

the client.

X Eligibility criteria for referral to 

community service providers.

X Appropriate confidentiality rules and 

regulations.

X Terminologies appropriate to the referral 

source.

Skills

X Using appropriate technology to access, 

collect, summarize, and transmit referral 

data about the client.

X Communicating respect and empathy for 

cultural and lifestyle differences.

X Demonstrating appropriate oral and written communication.

X Establishing trust and rapport with colleagues in the community.

X Assessing the level and intensity of client 

care needed.

X Being aware of the need to consult with 

professionals in other disciplines and 

specialties.

Attitudes

X Respect for contributions and needs of 

multiple disciplines to the treatment 

process.

X Confidence in using diverse systems and 

treatment approaches.

X Openmindedness to a variety of treatment 

approaches.

X Willingness to modify or adapt plans.

Competency 56:

Initiate collaboration with the referral source.

Element: Implementing the Treatment Plan
81

PD IV. Service Coordination

Knowledge

X Methods for obtaining relevant screening, 

assessment, and initial treatment 

planning information.

How to interpret information for service 

coordination.

Theories, concepts, and philosophies of 

screening and assessment tools.

How to define long- and short-term goals 

of treatment.

Biopsychosocial assessment methods.

Skills

X Using accurate, clear, and concise oral 

and written communication.

Interpreting, prioritizing, and using client 

information.

Soliciting comprehensive and accurate 

information from numerous sources, 

including the client.

Using appropriate technology to 

document appropriate information.

Attitudes

X Appreciation for all sources and types of 

data and their possible treatment 

implications.

Awareness of personal biases that may 

affect work with the client.

Respect for the client’s self-assessment 

and reporting.

Competency 57:

Obtain, review, and interpret all relevant screening, assessment, and initial 

treatment planning information.
82

Knowledge

X Philosophies, policies, procedures, 

and admission protocols for community 

agencies.

Eligibility criteria for referral to 

community service providers.

Principles for tailoring treatment to client 

needs.

Methods of assessing and documenting 

client change over time.

Federal and State confidentiality rules and 

regulations and clients’ privacy rights.

Skills

X Working with the client to select the most 

appropriate treatment.

Accessing available funding resources.

Using effective communication styles.

Recognizing, documenting, and communicating client change.

Involving family and significant others in 

the treatment planning process.

Effectively interviewing and communicating with clients who have cognitive or 

psychiatric impairments.

Accurately describing the client’s signs 

and symptoms of cognitive or psychiatric 

impairment when consulting with medical 

and mental health professionals.

Attitudes

X Recognition of the importance of 

continued support, encouragement, 

and optimism.

Willingness to accept the limitations of 

treatment.

Appreciation for the goal of selfdetermination.

Recognition of the importance of family 

and significant others to treatment 

planning.

Appreciation for the need for continuing 

assessment and modifications to the 

treatment plan.

Competency 58:

Confirm the client’s eligibility for admission and continued readiness for 

treatment and change.

Addiction Counseling Competencies
83

PD IV. Service Coordination

Knowledge

X Admission criteria and protocols.

Documentation requirements and 

confidentiality rules and regulations.

Appropriate Federal, State, and local 

regulations related to admission.

Funding mechanisms, reimbursement 

protocols, and required documentation.

Protocols required by managed care 

organizations.

Skills

X Demonstrating accurate, clear, and concise 

oral and written communication.

Using language the client easily 

understands.

Negotiating with diverse treatment 

systems.

Advocating for services for the client.

Attitudes

X Acceptance of the necessity to deal with 

bureaucratic systems.

Recognition of the importance of 

collaboration.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Competency 59:

Complete necessary administrative procedures for admission to treatment.
84

Addiction Counseling Competencies

Knowledge

X Functions and resources provided by 

treatment services and managed care 

systems.

X Available community services.

X Effective communication styles.

X Clients’ rights and responsibilities.

X Treatment schedule, timeframes, 

admission and discharge criteria, 

and costs.

X Rules and regulations of the treatment 

program.

X Roles and limitations of significant others 

in treatment.

X How to apply confidentiality rules and 

regulations and clients’ privacy rights.

Skills

X Demonstrating clear and concise oral and 

written communication.

X Establishing appropriate boundaries with 

the client and significant others.

Attitudes

X Respect for the input of the client and 

significant others.

Competency 60:

Establish accurate treatment and recovery expectations with the client and 

involved significant others, including but not limited to:

u The nature of services

u Program goals

u Program procedures

u Rules regarding client conduct

u The schedule of treatment activities

u Costs of treatment

u Factors affecting duration of care

u Clients’ rights and responsibilities

u The effect of treatment and recovery on 

significant others.
85

PD IV. Service Coordination

Knowledge

X Methods for determining the client’s 

progress in achieving treatment goals and 

objectives.

Documentation and reporting methods 

used by community agencies.

Service reimbursement issues and their 

effect on the treatment plan.

Case presentation techniques and 

protocols.

Applicable confidentiality rules and 

regulations.

Terminology and methods used by 

community agencies.

Skills

X Delivering case presentations.

Using appropriate technology to collect 

and interpret client treatment information 

from diverse sources.

Demonstrating accurate, clear, and concise 

oral and written communication.

Participating in interdisciplinary team 

building.

Participating in negotiation, advocacy, 

conflict resolution, problemsolving, 

and mediation.

Attitudes

X Willingness to collaborate with community 

agencies and service providers.

Competency 61:

Coordinate all treatment activities with services provided to the client by 

other resources.

Uses of The Competencies

The Competencies is the foundation for addiction counseling coursework at the University of 

Nevada–Reno and the University of Nevada–Las Vegas. Both institutions offer an undergraduate 

minor and a graduate emphasis in addiction counseling with a number of courses developed 

directly from The Competencies. In addition, all instructors and students in these counseling 

programs are provided copies of the publication.
86

Element: Consulting

Addiction Counseling Competencies

Knowledge

X Methods for assessing the client’s past 

and present biopsychosocial status.

Methods for assessing social systems 

that may affect the client’s progress in 

treatment.

Methods for continuous assessment and 

modification of the treatment plan.

Methods for assessing progress toward 

treatment goals.

Skills

X Demonstrating clear and concise oral and 

written communication.

Synthesizing information and developing 

modified treatment goals and objectives.

Soliciting and interpreting feedback related to the treatment plan.

Prioritizing and documenting relevant 

client data.

Observing and identifying problems that 

might impede progress.

Soliciting client satisfaction feedback.

Attitudes

X Respect for the personal nature of the 

information shared by the client and 

significant others.

Respect for interdisciplinary work.

Appreciation for incremental progress in 

completing treatment goals.

Recognition of relapse as an opportunity 

for positive change.

Competency 62:

Summarize the client’s personal and cultural background, treatment plan, recovery progress, and problems inhibiting progress to ensure quality of care, 

gain feedback, and plan changes in the course of treatment.
87

PD IV. Service Coordination

Knowledge

X Functions and unique terminology of 

related disciplines.

Skills

X Demonstrating accurate, clear, and concise 

oral and written communication.

Participating in interdisciplinary 

collaboration.

Interpreting oral and written data from 

various sources.

Attitudes

X Confidence in asking questions and 

providing information across disciplines.

Competency 63:

Understand the terminology, procedures, and roles of other disciplines 

related to the treatment of substance use disorders.

Knowledge

X Roles, responsibilities, and areas of 

expertise of other team members and 

professional disciplines.

Confidentiality rules and regulations.

Team dynamics and group process.

Skills

X Demonstrating clear and concise oral and 

written communication.

X Participating in problemsolving, 

decisionmaking, mediation, and advocacy.

Communicating about confidentiality 

issues.

Coordinating the client’s treatment with 

representatives of multiple disciplines and 

external systems.

Participating in team building and group 

process.

Attitudes

X Interest in cooperation and collaboration 

with diverse service providers.

Respect and appreciation for other 

team members and their professional 

disciplines.

Recognition of the need to consult with 

professionals in other disciplines and 

specialties.

Competency 64:

Contribute as part of a multidisciplinary treatment team.
88

Addiction Counseling Competencies

Uses of The Competencies

Kathryn Miller, Ph.D., associate professor at San Antonio College, used The Competencies as the 

basis for the article “A Resource for Addiction Counseling: LCDCs in Texas” published in the Texas 

Counseling Association Journal. The article explains to graduate-level counselors the scope of 

chemical dependency counseling practice and encourages cooperation between counseling 

generalists and specialists.

Knowledge

X Federal, State, and local confidentiality 

rules and regulations, especially as they 

apply to substance abuse treatment, 

health care, mental health care, child 

welfare, and criminal justice.

How to apply confidentiality rules and 

regulations to documentation and sharing 

of client information.

Ethical standards related to confidentiality 

rules and regulations.

Clients’ rights and responsibilities.

How to apply confidentiality rules and 

regulations in emergency situations 

(medical/suicide prevention/mandatory 

reports of child abuse or neglect 

situations).

Skills

X Explaining and applying confidentiality 

rules and regulations.

Obtaining informed consent.

Communicating with the client, 

family and significant others, and other 

service providers within the boundaries 

of existing confidentiality rules and 

regulations.

Communicating the need for client referral 

information in emergency situations and 

documenting these encounters.

Attitudes

X Recognition of the importance of 

confidentiality rules and regulations.

Respect for a client’s right to privacy.

Recognition of the need to seek support 

or supervision in client health and safety 

emergency situations.

Competency 65:

Apply confidentiality rules and regulations appropriately.
89

PD IV. Service Coordination

Knowledge

X Behaviors appropriate to professional 

collaboration.

Clients’ rights and responsibilities.

Skills

X Establishing and maintaining nonjudgmental, respectful relationships with clients 

and service providers.

Demonstrating clear, concise, accurate 

communication with other professionals 

or agencies.

Applying confidentiality rules and regulations when communicating with agencies.

Transferring client information to other 

service providers in a professional manner.

Advocating with outside systems.

Attitudes

X Willingness to advocate on behalf of the 

client.

Professional concern for the client.

Commitment to professionalism.

Competency 66:

Demonstrate respect and nonjudgmental attitudes toward clients in all 

contacts with community professionals and agencies.

Uses of The Competencies

The Florida Certification Board (FCB) used the national standards for substance abuse counseling 

set forth in The Competencies to standardize the process of certification in the State of Florida 

and elevate the level of professionalism in the substance abuse treatment field. In 2003 FCB used 

this publication to develop Scopes of Professional Practice for three levels of addiction certification 

in Florida. To enhance the three Scopes of Practice, FCB expanded the educational requirements 

for certification. Using The Competencies to identify the specific educational content individuals 

would need to become certified according to the new Scopes of Practice, the educational components for certification were updated to include specific hours in each transdisciplinary foundation 

and practice dimension. Providers of continuing education for FCB are now required to detail the 

educational/training content on certificates to match the transdisciplinary foundations and 

practice dimensions.
90

Addiction Counseling Competencies

Knowledge

X Social, cultural, and family systems.

Techniques to engage the client in 

treatment process.

Outreach, followup, and continuing care 

techniques.

Methods for determining the client’s 

goals, treatment plan, and motivational 

level.

Assessment mechanisms to measure the 

client’s progress toward treatment 

objectives.

Skills

X Engaging the client, family, and significant 

others in the ongoing treatment process.

Assessing client progress toward treatment 

goals.

Helping the client maintain motivation to 

change.

Assessing the comprehension level of the 

client, family, and significant others.

Documenting the client’s adherence to the 

treatment plan.

Recognizing and addressing ambivalence 

and resistance.

Implementing followup and continuing 

care protocols.

Attitudes

X Respect for client’s efforts to achieve 

treatment goals.

Appreciation for incremental progress in 

completing treatment goals.

Respect for client’s choice of treatment 

goals.

Professional concern for the client, 

the family, and significant others.

Recognition of the importance of 

continued support, encouragement, 

and optimism.

Recognition of relapse as an opportunity 

for positive change.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Competency 67:

Maintain ongoing contact with the client and involved significant others to 

ensure adherence to the treatment plan.

Element: Continuing Assessment and Treatment Planning
91

PD IV. Service Coordination

Knowledge

X How to recognize incremental progress 

toward treatment goals.

The client’s cultural norms, biases, 

unique characteristics, and preferences 

for treatment.

Generally accepted treatment outcome 

measures.

Methods for evaluating treatment 

progress.

Methods for assessing the client’s 

motivation and adherence to treatment 

plans.

Theories and principles of the stages of 

change and recovery.

Skills

X Identifying and documenting change.

Assessing adherence to treatment plans.

Applying treatment outcome measures.

Communicating with people of other 

cultures.

Reinforcing positive change.

Attitudes

X Appreciation for cultural issues that affect 

treatment progress.

Respect for individual differences and 

readiness to change.

Recognition of the importance of 

continued support, encouragement, 

and optimism.

Competency 68:

Understand and recognize stages of change and other signs of treatment 

progress.

Uses of The Competencies

The Competencies has been used as a resource by instructors in developing online courses for 

Access ED, in presenting the Mid-Atlantic ATTC’s Center for Online Courses, and for traditional 

classroom delivery tailored to counselors, case managers, and supervisors. In Virginia specifically, 

The Competencies guided the design of the Virginia Institute for Professional Addictions Counselor 

Training (VIPACT) curriculum, which provides the didactic hours required for the Virginia Certified 

Substance Abuse Counselor credential. This program has been delivered to nondegreed, as well as 

B.S.- and M.S.-prepared, counselors and case managers over the past 3 years. VIPACT was developed 

and continues to be delivered under a cooperative agreement between the Mid-Atlantic ATTC and 

the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services.
92

Addiction Counseling Competencies

Knowledge

X Continuum of care.

Interviewing techniques.

Stages in the treatment and recovery 

processes.

Individual differences in the recovery 

process.

Methods for evaluating treatment 

progress.

Methods for reinvolving the client in the 

treatment planning process.

Skills

X Participating in conflict resolution, 

problemsolving, and mediation.

Observing, recognizing, assessing, and 

documenting client progress.

Eliciting the client’s perspectives on 

progress.

Demonstrating clear and concise oral and 

written communication.

Interviewing individuals, groups, 

and families.

Acquiring and prioritizing relevant 

treatment information.

Assisting the client in maintaining 

motivation.

Maintaining contact with the client, 

referral sources, and significant others.

Attitudes

X Willingness to be flexible.

Respect for the client’s right to 

self-determination.

Appreciation of the role significant others 

play in the recovery process.

Appreciation of individual differences in 

the recovery process.

Competency 69:

Assess treatment and recovery progress, and, in consultation with the client 

and significant others, make appropriate changes to the treatment plan to 

ensure progress toward treatment goals.
93

PD IV. Service Coordination

Knowledge

X Treatment modalities.

Documentation of process, progress, 

and outcome.

Factors affecting the client’s success in 

treatment.

Generally accepted outcome measures.

Treatment planning.

Skills

X Demonstrating clear and concise oral 

and written communication.

Observing and assessing client progress.

Engaging the client in the treatment 

process.

Applying progress and outcome measures.

Attitudes

X Appreciation of the importance of 

accurate documentation.

Recognition of the importance of 

multidisciplinary treatment planning.

Competency 70:

Describe and document the treatment process, progress, and outcome.

Knowledge

X Treatment outcome measures.

Concepts of validity and reliability of 

outcome measures.

Skills

X Using outcome measures in the treatment 

planning process.

Attitudes

X Appreciation of the need to measure 

outcomes.

Competency 71:

Use accepted treatment outcome measures.

Uses of The Competencies

The Northeast (Ne) ATTC instructs vendors and fellowship applicants to use The Competencies

when designing and developing NeATTC-sponsored training curricula, educational products, and 

services. This activity helps agencies and individuals institutionalize the use of The Competencies

as a tool in project planning and subsequent project activity.
94

Addiction Counseling Competencies

Knowledge

X Treatment planning process.

Continuum of care.

Social and family systems available for 

continuing care.

Community resources available for 

continuing care.

Signs and symptoms of relapse.

Relapse prevention strategies.

Family and social systems theories.

Discharge planning process.

Confidentiality rules and regulations.

Skills

X Accessing information from referral 

sources.

Demonstrating clear and concise oral 

and written communication.

Assessing and documenting treatment 

progress.

Participating in confrontation, 

conflict resolution, and problemsolving.

Collaborating with referral sources.

Engaging the client and significant others 

in the treatment process and continuing 

care.

Assisting the client in developing a relapse 

prevention plan.

Attitudes

X Recognition of the importance of 

continued support, encouragement, 

and optimism.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Competency 72:

Conduct continuing care, relapse prevention, and discharge planning with 

the client and involved significant others.
95

PD IV. Service Coordination

Knowledge

X Documentation requirements, 

including but not limited to:

– addiction counseling

– other disciplines

– funding sources

– agencies and service providers.

Service coordination role in the 

treatment process.

Skills

X Demonstrating clear and concise written 

communication.

Using appropriate technology to report 

information in an accurate and timely 

manner within the bounds of 

confidentiality rules and regulations.

Attitudes

X Acceptance of documentation as an 

integral part of the treatment process.

Willingness to use appropriate technology.

Competency 73:

Document service coordination activities throughout the continuum of care.

Knowledge

u

u

u

u

u

u

Treatment planning along the continuum 

of care.

Initial and ongoing placement criteria.

Methods to assess current and ongoing 

client status.

Stages of progress associated with 

treatment modalities.

Appropriate discharge indicators.

Managed care continuing care criteria 

and utilization review procedures.

Competency 74:

Apply placement, continued stay, and discharge criteria for each modality on 

the continuum of care.
96

Addiction Counseling Competencies

Bibliography

PD IV. Service Coordination

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Alcohol and Drug Problems: A Practical Guide for Counsellors (2nd ed.). Toronto, Canada: 

Addiction Research Foundation, 61-76.

Bokos, P.J., Mejta, C.L., et al. (1993). A case management model for intravenous drug users. 

In J.A. Inciardi, R.M. Tims, & B.W. Fletcher (Eds.) Innovative Approaches in the Treatment of 

Drug Abuse—Program Models and Strategies. Westport, CT: Greenwood Press, 87-96.

Brindis, C., Pfeffer, R., & Wolfe, A. (1995). A case management program for chemically 

dependent clients with multiple needs. Journal of Case Management, 4:22-28.

Brindis, C.D., & Theidon, K.S. (1997). The role of case management in substance abuse 

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Brown, T.G., Seraganian, P., et al. (2002). Matching substance abuse aftercare treatment to client 

characteristics. Addictive Behavior, 27(4):585-604.

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98
99

Practice Dimension V

COUNSELING
100
101

PD V. Counseling

Elements:

u

u

u

Individual Counseling

Group Counseling

Counseling, Families, Couples, and Significant Others

Definition: A collaborative process that facilitates the client’s progress toward mutually 

determined treatment goals and objectives.

Counseling includes methods that are sensitive to individual client characteristics and to the 

influence of significant others, as well as the client’s cultural and social context. Competence 

in counseling is built on an understanding of, appreciation of, and ability to appropriately 

use the contributions of various addiction counseling models as they apply to modalities of 

care for individuals, groups, families, couples, and significant others.

Element: Individual Counseling

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Knowledge

X Theories, research, and evidence-based 

literature.

Approaches to counseling that are person 

centered and have demonstrated 

effectiveness with substance use disorders.

Definitions of warmth, respect, 

genuineness, concreteness, and empathy.

The role of the counselor.

Transference and countertransference.

Skills

X Active listening, including paraphrasing, 

reflecting, and summarizing.

Conveying warmth, respect, 

and genuineness in a culturally 

appropriate manner.

Validating.

Demonstrating empathic understanding.

Using power and authority appropriately 

in support of treatment goals.

Attitudes

X Respect for the client.

Recognition of the importance of 

cooperation and collaboration with 

the client.

Professional objectivity.

Competency 75:

Establish a helping relationship with the client characterized by warmth, 

respect, genuineness, concreteness, and empathy.
102

Addiction Counseling Competencies

Knowledge

X Theory and research related to client 

motivation.

Alternative theories and methods for 

motivating the client in a culturally 

appropriate manner.

Theory, research, and evidence-based 

literature.

Counseling strategies that promote and 

support successful client engagement.

Stages-of-change models used in 

engagement and treatment strategies.

Skills

X Implementing appropriate engagement 

and interviewing approaches.

Assessing the client’s readiness for change.

Using culturally appropriate counseling 

strategies.

Assessing the client’s responses to 

therapeutic interventions.

Attitudes

X Respect for the client’s frame of reference 

and context.

Competency 76:

Facilitate the client’s engagement in the treatment and recovery process.

Knowledge

X Assessment and treatment planning.

Stages of change and recovery.

Strategies to support recovery.

Skills

X Formulating and documenting concise, 

descriptive, and measurable treatment 

outcome statements.

Facilitating the client’s ability to determine 

goals and formulate action plans.

Knowing one’s limitations with respect to 

the therapeutic relationship.

Attitudes

X Appreciation for the client’s resources and 

preferences.

Appreciation for individual differences in 

the treatment and recovery process.

Competency 77:

Work with the client to establish realistic, achievable goals consistent with 

achieving and maintaining recovery.
103

PD V. Counseling

Uses of The Competencies

In Idaho, the State certification board and the Idaho Educators in Addiction Studies collaborated 

to establish a new entry-level counselor certification for the State. Educational requirements for 

certification were based on The Competencies. To facilitate the process, college faculty members 

were trained in competency-based teaching methods to enhance student proficiency.

Knowledge

X Information, skills, and attitudes 

consistent with recovery.

The client’s goals, treatment plan, 

prognosis, and motivational level.

Stages-of-change model.

Assessment methods to measure progress 

in achieving treatment goals and 

objectives.

Skills

X Implementing motivational techniques.

Recognizing the client’s strengths.

Assessing and providing feedback on client 

progress toward treatment goals.

Assessing life and basic skills and 

comprehension levels of the client and all 

significant others involved in the treatment 

planning process.

Identifying and documenting change.

Coaching, mentoring, teaching, and 

validating.

Recognizing and addressing ambivalence 

and resistance.

Attitudes

X Genuine care and concern for the client, 

family, and significant others.

Appreciation for incremental progress in 

completing treatment goals.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Competency 78:

Promote client knowledge, skills, and attitudes that contribute to a positive 

change in substance use behaviors.
104

Knowledge

X Counseling theory, treatment, and 

practice literature as it applies to 

substance use disorders.

Relapse prevention theory, practice, 

and outcome literature.

Behaviors and cognition consistent 

with the development, maintenance, 

and attainment of treatment goals.

Counseling treatment methods that 

support positive client behaviors 

consistent with recovery.

Skills

X Using behavioral and cognitive methods 

and other interventions that reinforce 

positive client behaviors.

Using objective observation and 

documentation.

Assessing and reassessing client behaviors.

Attitudes

X Recognition of the importance of 

continued support, encouragement, 

and optimism.

Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Appreciation for incremental progress in 

completing treatment goals.

Competency 79:

Encourage and reinforce client actions determined to be beneficial in 

progressing toward treatment goals.

Addiction Counseling Competencies
105

PD V. Counseling

Knowledge

X The client’s history and treatment plan.

The client’s behaviors and cognition 

that are inconsistent with the recovery 

process.

Behavioral and cognitive therapy 

literature relevant to substance use 

disorders.

Cognitive, behavioral, and pharmacological interventions appropriate for relapse 

prevention.

Strengths-based models that build 

on strengths of the client.

Skills

X Monitoring the client’s behavior for 

consistency with established treatment 

outcomes.

Presenting inconsistencies between the client’s behaviors and goals.

Reframing and redirecting negative 

behaviors.

Teaching conflict resolution, decisionmaking, and problemsolving skills.

Recognizing and addressing underlying 

client issues that may impede treatment 

progress.

Engaging client to discover and use 

personal strengths and resources to 

achieve goals.

Attitudes

X Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Acceptance of relapse as an opportunity 

for positive change.

Recognition of the value of a constructive 

helping relationship.

Competency 80:

Work appropriately with the client to recognize and discourage all behaviors 

inconsistent with progress toward treatment goals.
106

Knowledge

X Theory, research, and outcome-based 

literature demonstrating the importance 

of significant others, including families 

and other social systems, to treatment 

progress.

Social and family systems theory.

How to apply appropriate confidentiality 

rules and regulations.

Skills

X Identifying the client’s family and social 

systems.

Recognizing the effect of the client’s 

family and social systems on the 

treatment process.

Engaging significant others in the 

treatment process.

Attitudes

X Appreciation for the need of significant 

others to be involved in the client’s 

treatment plan, within the bounds of 

confidentiality rules and regulations.

Respect for the contribution of significant 

others to the treatment process.

Competency 81:

Recognize how, when, and why to involve the client’s significant others in 

enhancing or supporting the treatment plan.

Addiction Counseling Competencies
107

PD V. Counseling

Knowledge

X The client’s and system’s worldviews 

relative to health.

How infectious diseases are transmitted 

and prevented.

The relationship among substanceabusing lifestyles, risky sexual behaviors, 

and the transmission of infectious 

diseases.

Health enhancement concepts, research, 

and methods.

Available community health care, support, 

and prevention resources.

Skills

X Using a repertoire of techniques that, 

based on an assessment of various client 

and system characteristics, promote and 

reinforce health-enhancing activities and 

safe sex practices.

Coaching, mentoring, and teaching 

techniques relative to the promotion and 

maintenance of health.

Demonstrating cultural and overall 

competence in discussing sexuality.

Facilitating client referral to available 

community resources.

Attitudes

X Openness to discussions about health 

issues, lifestyle, and sexuality.

Recognition of the counselor’s potential 

to model a healthy lifestyle.

Competency 82:

Promote client knowledge, skills, and attitudes consistent with the 

maintenance of health and prevention of HIV/AIDS, tuberculosis, 

sexually transmitted diseases, hepatitis C, and other infectious diseases.
108

Knowledge

X Basic and life skills associated with 

recovery.

Theory, research, and practice literature 

that examines the relationship of basic 

and life skills to the attainment of positive 

treatment outcomes.

Tools used to determine levels of basic 

and life skills.

Skills

X Teaching and facilitating the adoption of 

life skills appropriate to the client’s situation and skill level.

Applying assessment tools to determine 

the client’s level of basic and life skills.

Communicating how basic and life skills 

relate to treatment outcomes.

Attitudes

X Recognition that recovery involves a life 

context broader than the elimination of 

symptoms.

Acceptance of relapse as an opportunity 

for learning and/or skills acquisition.

Competency 83:

Facilitate the development of basic and life skills associated with recovery.

Addiction Counseling Competencies

Knowledge

X The effect of culture on substance use.

Cultural factors affecting responsiveness 

to various counseling strategies.

Current research concerning differences 

in drinking and substance use patterns 

based on the characteristics of the client.

Addiction counseling strategies.

How to apply appropriate strategies based 

on the client’s treatment plan.

The client’s family and social systems and 

relationships between each.

The client’s and system’s cultural norms, 

biases, and preferences.

Literature relating spirituality to addiction 

and recovery.

Skills

X Knowing how to individualize treatment 

plans.

Adapting counseling strategies to unique 

client characteristics and circumstances.

Applying culturally and linguistically 

responsive communication styles and 

practices.

Attitudes

X Recognition of the need for flexibility in 

meeting the client’s needs.

Willingness to adjust strategies in 

accordance with the client’s characteristics.

A nonjudgmental, respectful acceptance of 

cultural, behavioral, and value differences.

Competency 84:

Adapt counseling strategies to the individual characteristics of the client, 

including but not limited to disability, gender, sexual orientation, developmental level, culture, ethnicity, age, and health status.
109

PD V. Counseling

Knowledge

X Client behaviors that tend to be 

inconsistent with recovery.

The client’s social and life circumstances.

Relapse prevention strategies.

Therapeutic interventions.

Skills

X Monitoring the client’s progress.

Using various methods to present 

inconsistencies between the client’s 

behaviors and treatment goals.

Reframing and redirecting negative 

behaviors.

Using appropriate communication and 

intervention strategies.

Attitudes

X Recognition of the importance of 

continued support, encouragement, 

and optimism.

Perseverance during periods of treatment 

difficulty.

Competency 85:

Make constructive therapeutic responses when the client’s behavior is 

inconsistent with stated recovery goals.
110

Knowledge

X Differences between crisis prevention, 

crisis intervention, and other kinds of 

therapeutic intervention.

Characteristics of a serious crisis and 

typical reactions.

Posttraumatic stress and other relevant 

psychiatric conditions.

Roles played by family and significant 

others in the crisis development or 

reaction.

Relationship of crisis to the client’s stage 

of change.

The client’s usual coping strategies.

Steps to aid in crisis resolution, 

including determination of what the 

client can do and what the counselor, 

family, or significant others in the client 

system should do, in accordance with 

the Health Insurance Portability and 

Accountability Act (HIPAA).

Skills

X Carrying out steps from crisis prevention 

to crisis resolution.

Assessing and engaging the client’s and client’s system’s strengths and resources.

Assessing for immediate concerns 

regarding safety and potential harm to 

others.

Possessing the ability to contract for safety.

Making appropriate referrals as necessary.

Assessing and acting on issues of 

confidentiality that may be part of a 

crisis response.

Assisting the client in expressing emotions 

and normalizing feelings.

Attitudes

X Recognition of crisis as an opportunity 

for change.

Confidence in the midst of crisis.

Recognition of personal and professional 

limitations.

Recognition of the need to practice crisis 

responses, particularly team interventions.

Competency 86:

Apply crisis prevention and management skills.

Addiction Counseling Competencies
111

PD V. Counseling

Knowledge

X How the client and client’s family, 

significant others, mutual-help groups, 

and other systems enhance and maintain 

treatment progress, relapse prevention, 

and continuing care.

Relapse prevention strategies.

Skills-training methods.

Skills

X Using behavioral techniques to reinforce 

positive client behaviors.

Teaching relapse prevention and life skills.

Motivating the client toward involvement 

in mutual-help groups.

Attitudes

X Recognition that clients must assume 

responsibility for their recovery.

Competency 87:

Facilitate the client’s identification, selection, and practice of strategies that 

help sustain the knowledge, skills, and attitudes needed for maintaining 

treatment progress and preventing relapse.
112

Knowledge

X A variety of group methods appropriate 

to achieving client objectives in a treatment population.

Research concerning the effectiveness of 

various models and strategies for group 

counseling with general populations.

Research concerning the effectiveness of 

various models and strategies for 

populations with substance use disorders.

Research and theory concerning the 

effectiveness of various models and 

strategies for group counseling with 

members of varying cultural groups.

Skills

X Designing and implementing strategies 

to meet the needs of specific groups.

Recognizing and accommodating 

appropriate individual needs within 

the group.

Leading therapeutic groups for clients 

with substance use disorders.

Using humor appropriately.

Attitudes

X Openness and flexibility in the choice of 

counseling strategies that meet the needs 

of the group and the individuals within the 

group.

Recognition of the value of the use of 

groups as an effective therapeutic 

intervention.

Competency 88:

Describe, select, and appropriately use strategies from accepted and 

culturally appropriate models for group counseling with clients with 

substance use disorders.

Addiction Counseling Competencies

Uses of The Competencies

In July 1999 a new mandatory Chemical Dependency Professional credentialing process was 

adopted in Washington State. Proficiency in specific addiction counseling competencies derived 

from The Competencies came to be required. Subsequently, college and university curricula within 

the State were required to be consistent with The Competencies.

Element: Group Counseling
113

PD V. Counseling

Knowledge

X Specific group models and strategies 

relative to the client’s age, gender, and 

cultural context.

Selection criteria, methods, 

and instruments for screening and 

selecting group members.

General principles for selecting group 

goals, outcomes, and ground rules.

General principles for appropriately 

graduating group members and 

terminating groups.

Principles of confidentiality rules and

regulations.

Skills

X Conducting screening interviews.

Assessing a client’s appropriateness for 

participation in group.

Using the group process to negotiate 

group goals, outcomes, and ground rules 

within the context of the individual needs 

and objectives of group members.

Using the group process to negotiate 

appropriate criteria and methods for 

transition to the next appropriate level 

of care.

Adapting group counseling skills as 

appropriate for the group type.

Considering environmental factors that 

facilitate group interactions, such as room 

setup and privacy issues.

Attitudes

X Recognition of the importance of involving 

group members in the establishment of 

group goals, outcomes, ground rules, and 

graduation and termination criteria.

Recognition of the fact that the nature of 

the specific group model depends on the 

needs, goals, outcomes, and cultural 

context of the participants.

Competency 89:

Carry out the actions necessary to form a group, including but not limited 

to determining group type, purpose, size, and leadership; recruiting and 

selecting members; establishing group goals and clarifying behavioral ground 

rules for participating; identifying outcomes; and determining criteria and 

methods for termination or graduation from the group.
114

Knowledge

X Developmental processes affecting 

therapeutic groups over time.

Issues faced by individuals and the group 

as a whole on entry of new members.

Issues faced by individuals and the group 

as a whole on exit of members.

Characteristics of transition stages in 

therapeutic groups.

Characteristics of therapeutic group 

behavior.

Skills

X Using the group process to prepare group 

members for transition and to resolve 

transitional issues.

Effectively addressing different types of 

resistant behaviors, transference issues, 

and countertransference issues.

Recognizing when members are ready 

to exit.

Attitudes

X Recognition of the need to balance 

individual needs with group needs, goals, 

and outcomes.

Appreciation for the contribution of new 

and continuing group members in the 

group process.

Maintenance of nonjudgmental attitudes 

and behaviors.

Respect for the emotional experience of 

the entry and exit of group members on 

the rest of the group.

Competency 90:

Facilitate the entry of new members and the transition of exiting members.

Addiction Counseling Competencies
115

PD V. Counseling

Knowledge

X Leadership, facilitator, and counselor 

methods appropriate for each group type 

and therapeutic setting.

Types and uses of power and authority in 

the therapeutic group process.

Stages of group development and 

counseling methods appropriate to 

each stage.

Skills

X Applying group counseling methods 

leading to measurable progress toward 

group and individual goals and outcomes.

Recognizing when and how to use 

appropriate power.

Documenting measurable progress toward 

group and individual goals.

Attitudes

X Recognition of the value of the use of 

different group counseling methods and 

leadership or facilitation styles.

Appreciation for the role and power of the 

group facilitator.

Appreciation for the role and power of 

various group members in the group 

process.

Competency 91:

Facilitate group growth within the established ground rules and movement 

toward group and individual goals by using methods consistent with group 

type.

Knowledge

X Concepts of process and content.

Difference between the group process 

and the content of the discussion.

Methods and techniques of group 

problemsolving, decisionmaking, 

and addressing group conflict.

How process variables affect the group’s 

ability to focus on content concerns.

How content variables affect the group’s 

ability to focus on process concerns.

Skills

X Observing and documenting process and 

content.

Assessing when to make appropriate 

process interventions.

Using strategies congruent with enhancing 

both process and content to meet 

individual and group goals.

Attitudes

X Appreciation of the appropriate use of 

content and process interventions.

Competency 92:

Understand the concepts of process and content, and shift the focus of the 

group when such a shift will help the group move toward its goals.
116

Addiction Counseling Competencies

Knowledge

X How individual treatment issues may 

surface in the context of group process.

Situations in which significant differences 

between individual and group goals 

require changing either the individual’s 

goals or the group’s focus.

Skills

X Recognizing that a client’s behavior can be, 

but is not always, reflective of the client’s 

treatment needs.

Documenting the client’s group behavior 

that has implications for treatment 

planning.

Recognizing the similarities and 

differences between individual needs 

and group processes.

Redesigning individual treatment plans 

based on the observation of group 

behaviors.

Attitudes

X Recognition of the value of accurate 

documentation.

Appreciation for individual differences in 

progress toward treatment goals and use 

of group intervention.

Competency 93:

Describe and summarize the client’s behavior within the group to document 

the client’s progress and identify needs and issues that may require a 

modification in the treatment plan.

Uses of The Competencies

The University of California–San Diego School of Medicine Forensic Certificate is based on 

The Competencies, criminology issues, and penology. The Competencies also serves as the 

minimum standard for the California Association of Addiction Certifying Organizations, a quality 

assurance body for the State.
117

PD V. Counseling

Element: Counseling Families, Couples, and Significant Others 

Knowledge

X Dynamics associated with substance use, 

abuse, dependence, and recovery in 

families, couples, and significant others.

The effect of interaction patterns on 

substance use behaviors.

Cultural factors related to the effect of 

substance use disorders on families, 

couples, and significant others.

Systems theory and dynamics.

Signs and patterns of domestic violence.

Effects of substance use behaviors on 

interaction patterns.

Skills

X Identifying systemic interactions that are 

likely to affect recovery.

Recognizing the roles of significant others 

in the client’s social system.

Recognizing potential for and signs and 

symptoms of domestic violence.

Attitudes

X Recognition of nonconstructive family 

behaviors as systemic issues.

Appreciation of the role systemic 

interactions play in substance use 

behavior.

Appreciation for diverse cultural factors 

that influence characteristics and dynamics 

of families, couples, and significant others.

Competency 94:

Understand the characteristics and dynamics of families, couples, and significant others affected by substance use.
118

Addiction Counseling Competencies

Knowledge

X Intervention strategies appropriate for 

family systems at varying stages of 

problem development and resolution.

Intervention strategies appropriate for 

violence against persons.

Laws and resources regarding violence 

against persons.

Culturally appropriate family intervention 

strategies.

Appropriate and available assessment 

tools for use with families, couples, 

and significant others.

Skills

X Applying assessment tools for use with 

families, couples, and significant others.

Applying culturally appropriate 

intervention strategies.

Attitudes

X Recognition of the validity of viewing 

the system (i.e., family, significant others, 

and extended kinship or tribal family 

structures) as the client views it, while 

respecting the rights and needs of 

individuals.

Appreciation for the diversity found in 

families, couples, and significant others.

Competency 95:

Be familiar with and appropriately use models of diagnosis and intervention 

for families, couples, and significant others, including extended, kinship, 

or tribal family structures.

Knowledge

X How to apply appropriate confidentiality 

rules and regulations.

Methods for engaging members of the 

family or significant others to focus on 

their concerns.

Skills

X Working within the bounds of 

confidentiality rules and regulations.

Identifying goals based on both 

individual and systemic concerns.

Using appropriate therapeutic 

interventions with system members that 

address established treatment goals.

Attitudes

X Recognition of the usefulness of working 

with those individual system members 

who are ready to participate in the 

counseling process.

Respect for confidentiality rules and 

regulations.

Competency 96:

Facilitate the engagement of selected members of the family or significant 

others in the treatment and recovery process.
119

PD V. Counseling

Knowledge

X The effect of family interaction patterns 

on substance use.

The effect of substance use on family 

interaction patterns.

Theory and research literature outlining 

systemic interventions in psychoactive 

substance abuse situations, including 

violence against persons.

Skills

X Describing systemic issues constructively 

to families, couples, and significant others.

Assisting system members in identifying 

and interrupting harmful interaction 

patterns.

Helping system members practice and 

evaluate alternative interaction patterns.

Attitudes

X Appreciation for the complexities of 

counseling families, couples, and significant others.

Competency 97:

Assist families, couples, and significant others in understanding the 

interaction between the family system and substance use behaviors.

Knowledge

X Healthy behavioral patterns for families, 

couples, and significant others.

Empirically based systemic counseling 

strategies associated with recovery.

Stages of recovery for families, couples, 

and significant others.

Skills

X Assisting system members in identifying 

and practicing behaviors to resolve the 

crises brought about by changes in 

substance use behaviors.

Assisting clients and family members with 

referral to appropriate support resources.

Assisting family members in identifying 

and practicing behaviors associated with 

long-term maintenance of healthy 

interactions.

Attitudes

X Appreciation for a variety of approaches 

to working with families, couples, and 

significant others.

Competency 98:

Assist families, couples, and significant others in adopting strategies and 

behaviors that sustain recovery and maintain healthy relationships.
120

Addiction Counseling Competencies

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Addiction Counseling Competencies

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130
131

Prac

tice

Dimension VI

CLIENT, FAMILY, 

AND COMMUNITY EDUCATION
132
133

PD VI. Client, Family, and Community Education

Definition: The process of providing clients, families, significant others, and community 

groups with information on risks related to psychoactive substance use, as well as available 

prevention, treatment, and recovery resources.

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Knowledge

X Cultural differences among ethnically 

and racially diverse communities.

Cultural differences in attitudes toward 

consumption of psychoactive substances.

Delivery of educational programs.

Research and theory on prevention of 

substance use problems.

Environmental strategies and prevention 

campaigns.

Learning styles and teaching methods.

Public speaking.

Benefits of working with community 

coalitions.

Skills

X Delivering prevention and treatment 

educational programs.

Facilitating discussion.

Identifying, creating, and modifying 

relevant educational materials to meet 

the needs of the intended audience.

Making public presentations.

Attitudes

X Awareness of and sensitivity to cultural 

differences.

Awareness of the potential need to adapt 

educational materials to respond to 

cultural differences.

Appreciation of the difference between 

educating and providing information.

Appreciation of the historical, social, 

cultural, and other influences that shape 

the perceptions of psychoactive 

substance use.

Competency 99:

Provide culturally relevant formal and informal education programs that 

raise awareness and support substance abuse prevention and the 

recovery process.
134

Addiction Counseling Competencies

Knowledge

X Individual, community, and family risk 

and protective factors.

The interactions of risk and protective 

factors and their influence on the 

development of substance abuse.

Skills

X Describing risk and protective factors 

as they relate to individual, community, 

school, and family domains.

Attitudes

X Sensitivity to the interaction of risk 

and protection in the development of 

substance use disorders.

Nonjudgmental presentation of issues.

Competency 100:

Describe factors that increase the likelihood for an individual, community, or 

group to be at risk for, or resilient to, psychoactive substance use disorders.

Knowledge

X Cultural issues in planning prevention 

and treatment programs.

Age and gender differences in 

psychoactive substance use.

Culture, gender, and age-appropriate 

prevention, treatment, and recovery 

resources.

Skills

X Communicating effectively with diverse 

populations.

Providing educational programs that 

reflect understanding of culture, ethnicity, 

age, and gender.

Attitudes

X Sensitivity to the role of culture, ethnicity, 

age, and gender in prevention, treatment, 

and recovery.

Awareness of one’s cultural biases.

Competency 101:

Sensitize others to issues of cultural identity, ethnic background, age, and 

gender in prevention, treatment, and recovery.
135

PD VI. Client, Family, and Community Education

Knowledge

X The continuum of use and abuse, 

including the warning signs and 

symptoms of a developing substance 

use disorder.

Current Diagnostic and Statistical Manual of Mental Disorders (DSM) categories 

or other diagnostic standards associated 

with psychoactive substance use.

Skills

X Identifying and teaching signs and 

symptoms of various substance use 

disorders.

Attitudes

X Recognition of the importance of research 

in prevention and treatment.

Competency 102:

Describe warning signs, symptoms, and the course of substance use 

disorders.

Uses of The Competencies

The Oregon Consortium of Addiction Studies Educators (OCASE) developed a core statewide 

curriculum for training addiction counselors based on The Competencies. All colleges in the State 

that offer any of the nine core courses included in the curriculum have committed to a common set 

of competency-based learning objectives.

The Wisconsin Association on Alcohol and Other Drug Abuse (WAAODA) uses The Competencies

as the primary framework and standard for its Minority Counselor Training Institute (MCTI) to 

develop highly qualified and culturally competent professionals from minority communities. 

WAAODA created the curriculum for MCTI by customizing and adding modules to the OCASE 

curriculum using The Competencies as a guide. Now medical schools and technical colleges in 

the State are considering adoption of this curriculum.

Knowledge

X How psychoactive substance use by one 

family member affects other family 

members or significant others.

The family’s potential positive or negative 

influence on the development and 

continuation of a substance use disorder.

The role of the family, couple, 

or significant other in treatment and 

recovery.

Skills

X Educating clients, families, and the 

community about the effect of substance 

use disorders on the family, couple, 

or significant others.

Attitudes

X Recognition of the unique response of 

family members and significant others to 

substance use disorders.

Competency 103:

Describe how substance use disorders affect families and concerned others.
136

Addiction Counseling Competencies

Knowledge

X The continuum of care.

Available treatment resources, including 

local health, allied health, and behavioral 

health resources.

Skills

X Motivating both family members and the 

client to seek out resources and services 

from the full continuum of care.

Describing different treatment modalities 

and the continuum of care.

Identifying and making referrals to local 

health, allied health, and behavioral health 

resources.

Attitudes

X Appreciation of strengths-based principles 

that emphasize client autonomy and skills 

development.

Appreciation of the difficulties families 

and significant others may encounter in 

seeking help.

Appreciation of ethnic and cultural 

differences.

Competency 104:

Describe the continuum of care and resources available to the family and 

concerned others.

Knowledge

X Models for prevention of, treatment of, 

and recovery from substance use 

disorders.

Research and theory on models of 

prevention, treatment, and recovery.

Influences on societal and political 

responses to substance use disorders.

Skills

X Organizing and delivering presentations 

that reflect basic information on 

prevention, treatment, and recovery.

Attitudes

X Appreciation of the importance of 

prevention and treatment.

Recognition of the validity of a variety of 

prevention and treatment strategies.

Competency 105:

Describe principles and philosophy of prevention, treatment, and recovery.
137

PD VI. Client, Family, and Community Education

Knowledge

X Health risks associated with substance use.

High-risk behaviors related to substance 

use.

Prevention and transmission of infectious 

diseases.

Factors that may be associated with the 

prevention or transmission of infectious 

diseases.

Community health and allied health 

resources.

Skills

X Teaching clients and community 

members about disease transmission 

and prevention.

Facilitating small- and large-group 

discussions.

Attitudes

X Awareness of one’s biases when presenting 

information.

Competency 106:

Understand and describe the health and behavior problems related to substance use, including transmission and prevention of HIV/AIDS, tuberculosis, 

sexually transmitted diseases, hepatitis C, and other infectious diseases.

Knowledge

X The importance of life skills to the 

prevention and treatment of substance 

use disorders.

How these skills are typically taught to 

individuals and groups.

Resources available to teach these skills.

Skills

X Delivering educational sessions.

Identifying and accessing other 

instructional resources for training.

Facilitating the practice and acquisition 

of life skills.

Attitudes

X Recognition of the importance of life skills 

training to the process of recovery.

Competency 107:

Teach life skills, including but not limited to stress management, relaxation, 

communication, assertiveness, and refusal skills.

Uses of The Competencies

In Iowa The Competencies is being used in a number of ways. The master’s program in Substance 

Abuse Counseling at the University of Iowa is based on The Competencies. The Competencies also 

is the basis for a “toolbox” training, through a subcontractor of the Prairielands ATTC, designed to 

educate entry-level substance abuse counselors about the skills needed for quality treatment and 

passing the State’s certification exam.

In addition, a graduate assistant at the Center of Excellence for Substance Abuse and Dually 

Diagnosed Persons at the University of Iowa is using the practice dimensions as a framework for his 

dissertation. He is assessing substance abuse counselors and their perceptions of the content areas 

in which they need and desire more supervision.
138

Addiction Counseling Competencies

Bibliography

PD VI. Client, Family, and Community Education

Amodeo, M., & Robb, N. (1997). Modifying methods and content to teach about alcohol and 

drug abuse cross-culturally. Substance Abuse, 18(1):1-12.

Bahr, S.J., & Hawks, R.D. (1993). Family and religious influences on adolescent substance 

abuse. Youth & Society, 24(4):443-465.

Brook, J.S., & Brook, D.W. (1996). Risk and protective factors for drug use. In C.B. McCoy, L.R. 

Metsch, & J.A. Inciardi (Eds.) Intervening With Drug-Involved Youth. Thousand Oaks, CA: 

Sage Publications, 23-44.

Brown, E.D., Maisto, S.A., & Boies-Hickman, K. Education. (1997). In E.D. Brown, T.J. O’Farrell, 

et al. (Eds.) Substance Abuse Program Accreditation Guide. Thousand Oaks, CA: Sage Publications, 71-76.

Center for Substance Abuse Prevention (1997). Technical Assistance Bulletin: Communicating 

Appropriately With Asian and Pacific Islander Audiences. Rockville, MD: Substance Abuse 

and Mental Health Services Administration.

Center for Substance Abuse Prevention (1997). Technical Assistance Bulletin: Developing 

Effective Messages and Materials for Hispanic/Latino Audiences. Rockville, MD: Substance 

Abuse and Mental Health Services Administration.

Center for Substance Abuse Prevention (1998). Technical Assistance Bulletin: Communicating 

With 9- to 14-Year-Old Girls. Rockville, MD: Substance Abuse and Mental Health Services 

Administration.

Center for Substance Abuse Prevention (1999). Understanding Substance Abuse Prevention—

Toward the 21st Century: A Primer on Effective Programs. DHHS Publication No. (SMA) 

99-3301. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Coggans, N., & Watson, J. (1995). Drug education: Approaches, effectiveness and delivery. 

Drugs: Education, Prevention and Policy, 2(3):211-224.

Connor, K.R., & Gunther, M.W. (1996). Educational lectures and films in the clinical treatment 

of alcoholism: A critique. Substance Use & Misuse, 31(9):1117-1129.

Delgado, M. (1997). Strengths-based practice with Puerto Rican adolescents: Lessons from a 

substance abuse prevention project. Social Work in Education, 19(2):101-112.

Dubas, J.S., Lynch, K.B., et al. (1998). Preliminary evaluation of a resiliency-based preschool 

substance abuse and violence prevention project. Journal of Drug Education, 

28(3):235-255.

Dusenbury, L., & Botvin, G.J. (1992). Substance abuse prevention: Competence enhancement 

and the development of positive life options. Journal of Addictive Diseases, 11(3):29-45.

Finn, P. (1994). Addressing the needs of cultural minorities in drug treatment. Journal of 

Substance Abuse Treatment, 11(4):325-337.

Gloria, A.M., & Peregoy, J.J. (1996). Counseling Latino alcohol and other substance users/

abusers. Journal of Substance Abuse Treatment, 13(2):119-126.

Goldberg, M.E. (1995). Substance-abusing women: False stereotypes and real needs. Social 

Work, 40(6):789-798.
139

PD VI. Client, Family, and Community Education

Harrington, N.G., & Donohew, L. (1997). Jump Start: A targeted substance abuse prevention 

program. Health Education & Behavior, 24(5):568-586.

Herring, R.D. (1994). Substance use among Native American Indian youth: A selected review of 

causality. Journal of Counseling & Development, 72(6):578-584.

Herrmann, D.S., & McWhirter, J.J. (1997). Refusal and resistance skills for children and 

adolescents: A selected review. Journal of Counseling & Development, 75(3):177-187.

Hogan, J. A., Gabrielson, K.R., et al. (2003). Substance Abuse Prevention: The Intersection of 

Science and Practice. Boston: Allyn & Bacon.

Joanning, H., Thomas, F., et al. (1992). Treating adolescent drug abuse: A comparison of 

family systems therapy, group therapy, and family drug education. Journal of Marital & 

Family Therapy, 18(4):345-356.

Kaskutas, L.A., Marsh, D., & Kohn, A. (1998). Didactic and experiential education in substance 

abuse programs. Journal of Substance Abuse Treatment, 15(1):43-53.

Leal, A. (1990). Hispanics and substance abuse: Implications for rehabilitation counselors. 

Journal of Applied Rehabilitation Counseling, 21(3):52-54.

Mirabeau, F. (1997). Evaluation outcome study of family education in the treatment of alcoholic 

patients. Journal of Addictions Nursing, 9(2):77-80.

Negreiros, J. (1994). Theoretical orientations in drug abuse prevention research. Drugs: Education, Prevention and Policy, 1(2):135-142.

Niemann, S.H. (2001). Guidance/psychoeducational groups. In D. Capuzzi & D.R. Gross (Eds.) 

Introduction to Group Counseling (3rd ed.). Denver, CO: Love Publishing Company, 

265-290.

O’Hara, P., Parris, D., et al. (1998). Influence of alcohol and drug use on AIDS risk behavior 

among youth in dropout prevention. Journal of Drug Education, 28(2):159-168.

O’Leary, T.A., Brown, S., et al. (2002). Treating adolescents together or individually? Issues in 

adolescent substance abuse interventions. Alcoholism: Clinical and Experimental Research, 

26(6):890-899.

Orenstein, A., & Ullman, A. (1996). Characteristics of alcoholic families and adolescent 

substance use. Journal of Alcohol and Drug Education, 41(3):86-101.

Pilgrim, C., Abbey, A., et al. (1998). Implementation and impact of a family-based substance 

abuse prevention program in rural communities. Journal of Primary Prevention, 

18(3):341-361.

Sheridan, M.J., & Green, R.G. (1993). Family dynamics and individual characteristics of adult 

children of alcoholics: An empirical analysis. Journal of Social Service Research, 

17(1-2):73-97.

Slaght, E., Lyman, S., et al. (2004). Promoting healthy lifestyles as a biopsychosocial approach to 

addictions counseling. Journal of Alcohol and Drug Education, 48(2):5-16.

Snow, D.L., Tebes, J.K., & Ayers, T.S. (1997). Impact of two social-cognitive interventions to 

prevent adolescent substance use: Test of an amenability to treatment model. Journal of 

Drug Education, 27(1):1-17.

Zweben, J.E. (2001). Hepatitis C: Education and counseling issues. Journal of Addictive 

Diseases, 20(1):33-42.
140
141

Prac

tice

Dimension VII

DOCUMENTATION
142
143

PD VII. Documentation

Definition: The recording of the screening and intake process, assessment, treatment plan, 

clinical reports, clinical progress notes, discharge summaries, and other client-related data.

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Knowledge

X Regulations pertaining to client records.

The essential components of client 

records, including release forms, assessments, treatment plans, progress notes, 

and discharge summaries and plans.

Skills

X Composing timely, clear, complete, 

and concise records that comply with 

regulations.

Documenting information in an objective 

manner.

Writing legibly.

Using new technologies in the production 

of client records.

Attitudes

X Appreciation of the importance of accurate 

documentation.

Competency 108:

Demonstrate knowledge of accepted principles of client record management.

Uses of The Competencies

During a 1999 survey of inpatient and outpatient programs at Georgia’s largest State psychiatric 

facility, Georgia Regional Hospital in Atlanta, The Competencies was used to develop standards for 

determining the competency of counselors, psychologists, and clinical supervisors working in 

substance abuse treatment services. The Competencies also was used to develop a policy procedure and test instrument for the facility by the Joint Commission on Accreditation of Healthcare 

Organizations.
144

Knowledge

X Federal, State, and program confidentiality 

rules and regulations.

The application of confidentiality rules 

and regulations.

Confidentiality rules and regulations 

regarding infectious diseases.

The legal nature of records.

Skills

X Applying Federal, State, and agency 

regulations regarding client confidentiality.

X Requesting, preparing, and completing 

release of information when appropriate.

Protecting and communicating clients’ 

rights.

Explaining regulations to clients and third 

parties.

Applying infectious disease regulations as 

they relate to addictions treatment.

Providing security for clinical records.

Attitudes

X Willingness to seek and accept supervision 

regarding confidentiality rules and 

regulations.

Respect for clients’ rights to privacy and 

confidentiality.

Commitment to professionalism.

Recognition of the absolute necessity of 

safeguarding records.

Competency 109:

Protect client rights to privacy and confidentiality in the preparation and 

handling of records, especially in relation to the communication of client 

information with third parties.

Addiction Counseling Competencies
145

PD VII. Documentation

Knowledge

X Essential elements of screening, intake, 

and assessment reports, including but 

not limited to:

– psychoactive substance use and

 abuse history

– physical health

– psychological information

– social information

– history of criminality

– spiritual information

– recreational information

– nutritional information

– educational or vocational information

– sexual information

– legal information.

Skills

X Analyzing, synthesizing, and summarizing 

information.

Keeping a concise and relevant record 

of information.

Organizing information in a presentable 

format for ease of access and review.

Documenting referral information.

Documenting source of referral 

information.

Attitudes

X Willingness to develop accurate reports.

Recognition of the importance of 

accurate records.

Competency 110:

Prepare accurate and concise screening, intake, and assessment reports.

Knowledge

X Current Federal, State, local, and program 

regulations.

Regulations regarding informed consent.

Skills

X Keeping timely, clear, complete, 

and concise records that comply with 

regulations.

Attitudes

X Recognition of the importance of 

recording treatment and continuing 

care plans.

Willingness to incorporate professional 

assessment in records.

Competency 111:

Record treatment and continuing care plans that are consistent with agency 

standards and comply with applicable administrative rules.
146

Addiction Counseling Competencies

Knowledge

X Appropriate clinical terminology used to 

describe client’s response to intervention 

and progress made toward completing 

treatment goals and objectives.

How to review and update records.

Skills

X Preparing clear and legible documents.

Documenting changes in the treatment 

plan, client status, client response to and 

outcome of interventions, level of care 

provided, and discharge status.

Using appropriate clinical terminology 

and standardized abbreviations.

Noting client’s strengths and limitations 

in achieving treatment goals.

Recording client’s response to and outcome of interventions.

Recording changes in client’s status, 

behavior, and level of functioning.

Noting limitations of treatment provided 

to client.

Attitudes

X Recognition of the value of objectively 

recording progress.

Recognition that timely recording is critical 

to accurate documentation.

Competency 112:

Record progress of client in relation to treatment goals and objectives.
147

PD VII. Documentation

Knowledge

X The components of a discharge summary, 

including but not limited to:

– client profile and demographics

– presenting symptoms

– diagnoses

– selected interventions

– critical incidents

– progress toward treatment goals

– outcome

– continuing care plan

– prognosis

– recommendations.

Skills

X Summarizing information.

Preparing concise discharge summaries.

Completing records in a timely manner.

Reporting measurable results.

Attitudes

X Recognition that treatment is not a static, 

singular event.

Recognition that recovery is ongoing.

Recognition that timely recording is critical 

to accurate documentation.

Competency 113:

Prepare accurate and concise discharge summaries.

Knowledge

X Accepted measures of treatment outcome.

Current research related to defining 

treatment outcomes.

Methods of gathering outcome data.

Principles of using outcome data for 

program evaluation.

Distinctions between process and 

outcome evaluation.

Skills

X Gathering and recording outcome data.

Incorporating outcome measures during 

the treatment process.

Attitudes

X Recognition that treatment and evaluation 

should occur simultaneously.

Appreciation of the importance of using 

data to improve clinical practice.

Competency 114:

Document treatment outcome, using accepted methods and instruments.
148

Addiction Counseling Competencies

Bibliography

PD VII. Documentation

Anderson, D. (1992). Case standards for counseling practice. Journal of Counseling &

Development, 71(September/October):22-26.

Badding, N.C. (1989). Client involvement in case recording: Social casework. Journal of 

Contemporary Social Work, (November):539-548.

Brown, E.D., O’Farrell, T.J., et al. (1997). Substance Abuse Program Accreditation Guide. 

Thousand Oaks, CA: Sage Publications. 

Clemens, N.A. (2001). Documenting psychotherapy: Getting help on HIPAA. Journal of 

Psychiatric Practice, 7(2):138-140.

Clemens, N.A. (2004). Documentation: The doctor’s dilemma. Journal of Psychiatric Practice, 

10(1):64-67.

Committee on Professional Practice and Standards (1993). Recordkeeping guidelines. American 

Psychologist, 48(September):984-986.

Eggland, E.T. (1995). Charting smarter: Using new mechanisms to organize your paperwork. 

Nursing, 25(September):34-42.

Finley, J.R., & Lenz, B.S. (Eds.) (2005). The Addiction Counselor’s Documentation Sourcebook: 

The Complete Paperwork Resource for Treating Clients With Addictions (2nd ed.). 

Hoboken, NJ: John Wiley & Sons.

Fulero, S.M., & Wilbert, J.R. (1988). Recordkeeping practices of clinical and counseling 

psychologists: A survey of practitioners. Professional Psychology Research and Practice, 

19:658-660.

Gwodz, D.T., & Del Togno, V. (1992). Streamlining patient care documentation. Journal of 

Nursing Administration, 22(May):35-39. 

Johnson, S.L. (2004). Therapist’s Guide to Clinical Intervention (2nd ed.). San Diego, CA: 

Elsevier, Inc.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2002). A Practical 

Guide to Documentation in Behavioral Health Care (2nd ed.). Oakbrook Terrace, IL: JCAHO.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2005). 2006-2007 

Comprehensive Accreditation Manual for Behavioral Health Care. Oakbrook Terrace, IL: 

JCAHO.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2005). 2006-2007 

Standards for Behavioral Health Care. Oakbrook Terrace, IL: JCAHO.

Kaczmarek, P., Barclay, D., & Smith, M. (1996). Systematic training in client documentation: 

Strategies for counselor educators. Counselor Education and Supervision, 36(September): 

77-84.

Kerr, S.D. (1992). A comparison of four nursing documentation systems. Journal of Nursing 

Staff Development, 8(January/February):276-331.
149

PD VII. Documentation

Kozier, B., Erb, G., & Oliveri, R. (1991). Fundamentals of Nursing: Concepts, Process and 

Practice (4th ed.). Redwood City, CA: Addison-Wesley.

Loganbill, C., & Stoltenberg, C. (1983). The case conceptualization format: A training device for 

practicum. Counselor Education and Supervision, 22: 235-241. 

Lopez, F. (1994). Confidentiality of Patient Records for Alcohol and Other Drug Treatment. 

Technical Assistance Publication (TAP) Series 13. DHHS Publication No. (SMA) 95-3018. 

Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health 

Services Administration.

Makover, R.B. (2004). Treatment Planning for Psychotherapists: A Practical Guide to Better 

Outcomes. Arlington, VA: American Psychiatric Publishing, Inc.

Marrelli, T.M. (2000). Nursing Documentation Handbook (3rd ed.). St. Louis, MO: Mosby.

Mitchell, R. (2001). Documentation in Counseling Records (2nd ed.). Alexandria, VA: American 

Counseling Association.

Moline, M.E., Williams, G.T., & Austin, K.M. (1997). Documenting Psychotherapy: Essentials for 

Mental Health Practitioners. Thousand Oaks, CA: Sage Publications.

Montemuro, M. (1988). CORE: Documentation: A complete system for documenting nursing 

care. Nursing Management, 19(August):28-32.

Presser, N.R., & Pfost, K.S. (1985). A format for individual psychotherapy session notes. 

Professional Psychology Research and Practice, 16:11-16.

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in Behavioral Health. Tucson, AZ: RAC.

Rehabilitation Accreditation Commission (RAC) (1999). Opioid Treatment Program 

Accreditation Standards. Tucson, AZ: RAC.

Rehabilitation Accreditation Commission (RAC) (1999). 2000 Behavioral Health Standards 

Manual. Tucson, AZ: RAC.

Scharf, L. (1997). Revising nursing documentation to meet patient outcomes. Nursing Management, 28(April):38-39.

Scoates, G.H., Fishman, M., & McAdam, B. (1997). Health Care Focus Documentation—More 

Efficient Charting. Nursing Management, 27(April):30-32.

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Corporation.

Springhouse Corporation (2002). Illustrated Manual of Nursing Practice (3rd ed.). 

Philadelphia: Lippincott Williams & Wilkins.

Sullivan, G. (1996). Is your documentation all it should be? RN, 59(October):59-61.

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278:593-600.

Wiger, D.E. (2005). The Clinical Documentation Sourcebook: The Complete Paperwork 

Resource for Your Mental Health Practice (3rd ed.). New York: John Wiley & Sons.
150

Addiction Counseling Competencies

Wiger, D.E. (2005). The Psychotherapy Documentation Primer. New York: John Wiley & Sons.

Wiger, D.E., & Solberg, K.B. (2001). Tracking Mental Health Outcomes: A Therapist’s Guide to 

Measuring Client Progress, Analyzing Data, and Improving Your Practice. New York: John 

Wiley & Sons.

Zuckerman, E.L. (2003). The Paper Office: Forms, Guidelines, and Resources To Make Your 

Practice Work Ethically, Legally, and Profitably (3rd ed.). New York: Guilford Press.
151

Prac

tice

Dimension VIII

PROFESSIONAL AND ETHICAL 

RESPONSIBILITIES
152
153

PD VIII. Professional and Ethical Responsibilities

Definition: The obligations of an addiction counselor to adhere to accepted ethical and 

behavioral standards of conduct and continuing professional development.

uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu

Knowledge

X Federal, State, agency, and professional 

codes of ethics.

Clients’ rights and responsibilities.

Professional standards and scope of 

practice.

Boundary issues between client and 

counselor.

Difference between the role of the 

professional counselor and that of a peer 

counselor or sponsor.

Consequences of violating codes of ethics.

Means for addressing alleged ethical 

violations.

Nondiscriminatory practices.

Mandatory reporting requirements.

Skills

X Demonstrating ethical and professional 

behavior.

Attitudes

X Openness to changing personal behaviors 

and attitudes that may conflict with ethical 

guidelines.

Willingness to participate in self, peer, 

and supervisory assessment of clinical 

skills and practice.

Respect for professional standards.

Competency 115:

Adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional 

standards and safeguard the client.
154

Addiction Counseling Competencies

Knowledge

X Federal, State, and agency regulations 

that apply to addiction counseling.

Confidentiality rules and regulations.

Clients’ rights and responsibilities.

Legal ramifications of noncompliance 

with confidentiality rules and regulations.

Legal ramifications of violating clients’ 

rights.

Grievance processes.

Skills

X Interpreting and applying appropriate 

Federal, State, and agency regulations 

regarding addiction counseling.

Making ethical decisions that reflect 

unique needs and situations.

Providing treatment services that conform 

to Federal, State, and local regulations.

Attitudes

X Appreciation of the importance of 

complying with Federal, State, and agency 

regulations.

Willingness to learn the appropriate 

application of Federal, State, and agency 

guidelines.

Competency 116:

Adhere to Federal and State laws and agency regulations regarding the 

treatment of substance use disorders.

Knowledge

X Professional literature on substance use 

disorders.

Information on current trends in 

addiction and related fields.

Professional associations.

Resources to promote professional 

growth and competency.

Skills

X Reading and interpreting current 

professional and research-based literature.

Applying professional knowledge to 

client-specific situations.

Applying research findings to clinical 

practice.

Applying new skills in clinically 

appropriate ways.

Attitudes

X Commitment to life-long learning and 

professional growth and development. 

Willingness to adjust clinical practice to 

reflect advances in the field.

Competency 117:

Interpret and apply information from current counseling and psychoactive 

substance use research literature to improve client care and enhance 

professional growth.
155

PD VIII. Professional and Ethical Responsibilities

Knowledge

X Differences found in diverse populations.

How individual differences affect 

assessment and response to treatment.

Personality, culture, lifestyle, and other 

factors influencing client behavior.

Culturally sensitive counseling methods.

Dynamics of family systems in diverse 

cultures and lifestyles.

Client advocacy needs specific to diverse 

cultures and lifestyles.

Signs, symptoms, and patterns of violence 

against persons.

Risk factors that relate to potential harm 

to self or others.

Hierarchy of needs and motivation.

Skills

X Assessing and interpreting culturally 

specific client behaviors and lifestyles.

Conveying respect for cultural and lifestyle 

diversity in the therapeutic process.

Adapting therapeutic strategies to 

client needs.

Attitudes

X Willingness to appreciate the life 

experiences of individuals.

Appreciation for diverse populations 

and lifestyles.

Recognition of one’s biases toward other 

cultures and lifestyles.

Competency 118:

Recognize the importance of individual differences that influence client 

behavior, and apply this understanding to clinical practice.

Uses of The Competencies

In 2000, the Northwest Frontier (NF) ATTC solicited a substance abuse treatment workforce survey 

in its region. Evaluators surveyed substance abuse treatment professionals (both front line and 

management) in Alaska, Idaho, Oregon, and Washington. Of 469 respondents, 63 percent were 

familiar with The Competencies. When asked how they used The Competencies, respondents 

indicated they used it for the following:

u 49 percent to improve their job performance

u 46 percent to guide their professional development

u 35 percent to improve treatment outcomes

u 32 percent for self-assessment

u 27 percent to assess job performance

u 22 percent to guide supervisory decisions.

A 2002 update of this survey in Alaska, Hawaii, Idaho, Oregon, and Washington showed that, of 609 

respondents, the majority of agency directors (79%) and treatment staff (61%) were familiar with 

The Competencies and, of those who reported familiarity, 80 percent actively used it in their work, 

showing a pattern of increasing use over time. A 2005 survey update, currently underway, will 

provide data on the most current uses of The Competencies. NFATTC has convened a regional 

workgroup, with participants from Alaska, Hawaii, Idaho, Oregon, and Washington, to develop 

teaching strategies specific to The Competencies. An educators’ “toolkit” of student exercises to use 

with The Competencies will be available on an educator’s Web page and in printed form and will 

be presented at educators’ workshops.
156

Addiction Counseling Competencies

Knowledge

X The role of supervision.

Models of supervision.

Potential barriers in the counselor–client 

relationship.

Transference and countertransference.

Resources for exploration of professional 

concerns.

Problemsolving methods.

Conflict resolution.

The process and effect of client 

reassignment.

The process and effect of termination of 

the counseling relationship.

Phases of treatment and client responses.

Skills

X Recognizing situations in which 

supervision is appropriate.

Developing a plan for resolution or 

improvement of feelings and concerns 

that may interfere with the counselor–

client relationship.

Seeking supervisory feedback.

Resolving conflicts.

Identifying overt and covert feelings and 

their effect on the counseling relationship.

Communicating feelings and concerns 

openly and respectfully.

Attitudes

X Willingness to accept feedback.

Acceptance of responsibility for personal 

and professional growth.

Awareness that one’s personal recovery 

issues have an effect on job performance 

and interactions with clients.

Competency 119:

Use a range of supervisory options to process personal feelings and concerns 

about clients.
157

PD VIII. Professional and Ethical Responsibilities

Knowledge

X Personal and professional strengths 

and limitations.

Legal, ethical, and professional standards 

affecting addiction counseling.

Consequences of failure to comply with 

professional standards.

Self-evaluation methods.

Regulatory guidelines and restrictions.

Skills

X Developing professional goals and 

objectives.

Interpreting and applying ethical, legal, 

and professional standards.

Using self-assessment tools for personal 

and professional growth.

Eliciting and applying feedback from 

colleagues and supervisors.

Attitudes

X Appreciation of the importance of 

self-evaluation.

Recognition of personal strengths, 

weaknesses, and limitations.

Willingness to change behaviors as 

necessary.

Competency 120:

Conduct self-evaluations of professional performance applying ethical, legal, 

and professional standards to enhance self-awareness and performance.

Knowledge

X Education and training methods that 

promote professional growth.

Recredentialing requirements.

Skills

X Assessing personal training needs.

Selecting and participating in appropriate 

training programs.

Using consultation and supervision as enhancements to professional growth.

Attitudes

X Recognition that professional growth 

continues throughout one’s professional 

career.

Willingness to expose oneself to 

information that may conflict with 

personal or professional beliefs.

Recognition that professional development 

is an individual responsibility.

Competency 121:

Obtain appropriate continuing professional education.
158

Addiction Counseling Competencies

Knowledge

X The rationale for regular assessment of 

professional skills and development.

Models of clinical and administrative 

supervision.

The rationale for using consultation.

Agency policy and protocols.

Case presentation methods.

How to identify needs for clinical or 

technical assistance.

Interpersonal dynamics in a supervisory 

relationship.

Skills

X Identifying professional progress and 

limitations.

Communicating the need for assistance.

Preparing and making case presentations.

Eliciting feedback from others.

Attitudes

X Willingness to accept both constructive 

criticism and positive feedback.

Respect for the value of clinical and 

administrative supervision.

Competency 122:

Participate in ongoing supervision and consultation.

Knowledge

X Rationale for periodic self-assessment 

regarding physical health, mental health, 

and recovery from substance use 

disorders.

Available resources for maintaining 

physical health, mental health, 

and recovery from substance use 

disorders.

Consequences of failing to maintain 

physical health, mental health, 

and recovery from substance use 

disorders.

Relationship between physical health 

and mental health.

Health promotion strategies.

Skills

X Carrying out regular self-assessment 

with regard to physical health, mental 

health, and recovery from substance 

use disorders.

Using prevention measures to guard 

against burnout.

Employing stress-reduction strategies.

Locating and accessing resources to 

achieve physical health, mental health, 

and recovery from substance use 

disorders.

Modeling self-care as an effective treatment 

tool.

Attitudes

X Recognition that counselors serve as role 

models.

Appreciation that maintaining a healthy 

lifestyle enhances the counselor’s 

effectiveness.

Competency 123:

Develop and use strategies to maintain one’s physical and mental health.
159

PD VIII. Professional and Ethical Responsibilities

Bibliography

PD VIII. Professional and Ethical Responsibilities

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American Methadone Treatment Association (AMTA) (1997). AMTA ethical canon for 

programs and individuals providing methadone treatment. Journal of Maintenance in 

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Bernard, J.M., & Goodyear, R.K. (2003). Fundamentals of Clinical Supervision (3rd ed.). 

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Section 3:

Additional Resources

u

u

u

u

Cultural Competency

 Internet Resources

 Attitudes Bibliography

 Recovery Bibliography

161
Addiction Counseling Competencies

162

Cultural Competency

Clients’ experiences of culture predate and influence their interaction with substance abuse 

treatment professionals. The majority of substance abuse treatment counselors are White, 

whereas nearly half of people who seek treatment are not White.1

 Regarding mental health 

services, clients who are not White express, at much higher rates than do White clients, 

the belief that they would have received better treatment if they were of another race.2

In addition to the references found in the bibliography for Transdisciplinary Foundation IV: 

Professional Readiness on pages 32 to 34, three Treatment Improvement Protocols (TIPs) 

provide information about cultural competency and substance abuse treatment. The forthcoming TIP Improving Cultural Competence in Substance Abuse Treatment is wholly devoted to 

the subject of culturally competent care. Information about the administrative challenges of 

preparing a program to provide culturally competent treatment can be found in chapter 4 of 

TIP 46, Substance Abuse: Administrative Issues in Outpatient Treatment, which includes an 

appendix listing resources for program assessment and cultural competency training. Chapter 

10 of TIP 47, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment, addresses 

the clinical implications of culturally competent treatment and includes the following:

X An introduction to current research supporting the need for individualized treatment 

that is sensitive to culture

Principles in the delivery of culturally competent treatment services

Topics of special concern, including foreign-born clients, women from other cultures, 

and religious considerations

Clinical implications of culturally competent treatment

Sketches of diverse client populations, including Hispanics/Latinos; African Americans; 

Native Americans; Asian Americans and Pacific Islanders; persons with HIV/AIDS; lesbian, 

gay, and bisexual populations; persons with physical and cognitive disabilities; rural 

populations; homeless populations; and older adults

An appendix that lists resources on culturally competent treatment for various 

populations.

1 Mulvey, K.P., Hubbard, S., & Hayashi, S. (2003). A national study of the substance abuse treatment workforce. 

 Journal of Substance Abuse Treatment, 24:51-57.

2

 La Veist, T.A., Diala, C., & Jarrett, N.C. (2000). Social status and perceived discrimination: Who experiences 

 discrimination in the health care system, how, and why? In C.J.R. Hogue, M.A. Hargraves, & K.S. Collins (Eds.) 

 Minority Health in America. Baltimore: Johns Hopkins University Press, 194-208.
Additional Resources

163

Internet Resources

The list below includes Web sites that address knowledge dissemination. These sites provide

good starting points for those wishing to follow up on the competencies, knowledge, skills,

and attitudes discussed in this Technical Assistance Publication.

X Substance Abuse and Mental Health Services Administration (SAMHSA) (http://www.

samhsa.gov)

SAMHSA’s Fetal Alcohol Spectrum Disorders Center for Excellence (http://fasdcenter.

samhsa.gov)

SAMHSA’s Knowledge Application Program (http://www.kap.samhsa.gov)

SAMHSA’s store, with information about the Health Information Network (http://www.

store.samhsa.gov/home)

SAMHSA’s store, with information about the National Mental Health Information Center 

(http://www.store.samhsa.gov/home)

SAMHSA’s Addiction Technology Transfer Centers (ATTCs) (http://www.nattc.org)

– Caribbean Basin and Hispanic ATTC (http://www.attcnetwork.org/regcenters/

index_caribbeanbasin.asp)

– Central East ATTC (http://www.attcnetwork.org/regcenters/index_centraleast.asp)

– Great Lakes ATTC (http://www.attcnetwork.org/regcenters/index_greatlakes.asp)

– Gulf Coast ATTC (http://www.attcnetwork.org/regcenters/index_gulfcoast.asp)

– Mid-America ATTC (http://www.attcnetwork.org/regcenters/index_midamerica.asp)

– Mid-Atlantic ATTC (http://www.attcnetwork.org/regcenters/index_midatlantic.asp)

– Mountain West ATTC (http://www.attcnetwork.org/regcenters/index_mountainwest.

asp)

– New England ATTC (http://www.attcnetwork.org/regcenters/index_newengland.asp)

– Northeast ATTC (http://www.attcnetwork.org/regcenters/index_northeast.asp)

– Northwest Frontier ATTC (http://www.attcnetwork.org/regcenters/

index_northwestfrontier.asp)

– Pacific Southwest ATTC (http://www.attcnetwork.org/regcenters/

index_pacificsouthwest.asp)

– Prairielands ATTC (http://www.attcnetwork.org/regcenters/index_prairielands.asp)

– Southeast ATTC (http://www.attcnetwork.org/regcenters/index_southeast.asp)

– Southern Coast ATTC (http://www.attcnetwork.org/regcenters/index_southerncoast.asp).

Health Resources and Services Administration (http://www.hrsa.gov)

National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov)

National Institute on Drug Abuse (http://www.nida.nih.gov)

Office of National Drug Control Policy (http://www.whitehousedrugpolicy.gov)
164

Attitudes Bibliography

Counselors’ attitudes toward clients and the treatment process are important because they 

shape the therapeutic relationship that is at the core of treatment for substance use disorders. 

Negative counselor attitudes need to be considered within the framework of stigma and its 

consequences for the counselor, the client, and the field. Attitudes of treatment professionals 

toward the multiple systems of bureaucracy with which they interact—agency priorities, 

clinic hierarchies, the criminal justice system, departments of social services, community 

organizations—may also affect their ability to deliver effective treatment.

Albery, I.P., Heuston, J., et al. (2003). Measuring therapeutic attitude among drug workers. 

Addictive Behaviors, 28(5):995-1005. 

Ball, S., Bachrach, K., et al. (2002). Characteristics, beliefs, and practices of community 

clinicians trained to provide manual-guided therapy for substance abusers. Journal of 

Substance Abuse Treatment, 23(4):309-318. 

Beauvais, F., Jumper-Thurman, P., et al. (2002). A survey of attitudes among drug user treatment 

providers toward the treatment of inhalant users. Substance Use & Misuse, 37(11):

1391-1410. 

Campbell, T.C., Catlin, L.A., & Melchert, T.P. (2003). Alcohol and other drug abuse counselors’ 

attitudes and resources for integrating research and practice. Journal of Drug Education, 

33(3):307-323. 

Caplehorn, J.R., Lumley, T.S., & Irwig, L. (1998). Staff attitudes and retention of patients in 

methadone maintenance programs. Drug and Alcohol Dependence, 52(1):57-61.

Carone, S.S., & LaFleur, N.K. (2000). The effect of adolescent sex offender abuse history on 

counselor attitudes. Journal of Addictions and Offender Counseling, 20(2):56-63. 

Culbreth, J.R., & Borders, L.D. (1998). Perceptions of the supervisory relationship: A preliminary 

qualitative study of recovering and nonrecovering substance abuse counselors. Journal of 

Substance Abuse Treatment, 15(4):345-352. 

Culbreth, J.R., & Borders, L.D. (1999). Perceptions of the supervisory relationship: Recovering 

and nonrecovering substance abuse counselors. Journal of Counseling & Development, 

77(3):330-338. 

Davis, T.D. (2005). Beliefs about confrontation among substance abuse counselors: Are they 

consistent with the evidence? In C. Hilarski (Ed.) Addiction, Assessment, and Treatment 

With Adolescents, Adults, and Families. Binghamton, NY: Haworth Social Work Practice 

Press, 1-17.

Eliason, M.J., & Hughes, T. (2004). Treatment counselor’s attitudes about lesbian, gay, bisexual, 

and transgendered clients: Urban vs. rural settings. Substance Use & Misuse, 39(4):625-644. 

Forman, R.F., Bovasso, G., & Woody, G. (2001). Staff beliefs about addiction treatment. 

Journal of Substance Abuse Treatment, 21(1):1-9. 
165

Forman, R.F., Bovasso, G., et al. (2002). Staff beliefs about drug abuse clinical trials. Journal of 

Substance Abuse Treatment, 23(1):55-60. 

Goddard, P. (2003). Changing attitudes towards harm reduction among treatment professionals: 

A report from the American Midwest. International Journal of Drug Policy, 14(3):257-260. 

Grosenick, J.K., & Hatmaker, C.M. (2000). Perceptions of staff attributes in substance abuse 

treatment. Journal of Substance Abuse Treatment, 19(3):273-284. 

Jacka, D., Clode, D., et al. (1999). Attitudes and practices of general practitioners training to 

work with drug-using patients. Drug and Alcohol Review, 18(3):287-291. 

Janikowski, T.P., & Glover-Graf, N.M. (2003). Qualifications, training, and perceptions of 

substance abuse counselors who work with victims of incest. Addictive Behaviors, 

28(6):1193-1201. 

Kasarabada, N.D., Hser, Y.I., et al. (2002). Do patients’ perceptions of their counselors influence 

outcomes of drug treatment? Journal of Substance Abuse Treatment, 23(4):327-334. 

Laudet, A.B. (2003). Attitudes and beliefs about 12-step groups among addiction treatment 

clients and clinicians: Toward identifying obstacles to participation. Substance Use & Misuse, 

38(14):2017-2047. 

Lawson, K.A., Wilcox, R.E., et al. (2004). Educating treatment professionals about addiction 

science research: Demographics of knowledge and belief changes. Substance Use & Misuse, 

39(8):1235-1258.

 Mark, T.L., Kranzler, H.R., et al. (2003). Physicians’ opinions about medications to treat 

alcoholism. Addiction, 98(5):617-626. 

Ogborne, A.C., Wild, T.C., et al. (1998). Measuring treatment process beliefs among staff of 

specialized addiction treatment services. Journal of Substance Abuse Treatment, 

15(4):301-312. 

Palm, J. (2004). The nature of and responsibility for alcohol and drug problems: Views among 

treatment staff. Addiction Research & Theory, 12(5):413-431. 

Project MATCH Research Group (1998). Therapist effects in three treatments for alcohol 

problems. Psychotherapy Research, 8(4):455-474. 

Rassool, G.H., & Lind, J.E. (2000). Perception of addiction nurses toward clinical supervision: 

An exploratory study. Journal of Addictions Nursing, 12(1):23-29. 

Shoptaw, S., Stein, J.A., & Rawson, R.A. (2000). Burnout in substance abuse counselors: 

Impact of environment, attitudes, and clients with HIV. Journal of Substance Abuse 

Treatment, 19(2):117-126. 

Tuchman, E., Gregory, C., et al. (2005). Office-based opioid treatment (OBOT): Practitioner’s 

knowledge, attitudes, and expectations in New Mexico. Addictive Disorders and Their 

Treatment, 4(1):11-19. 

Walton, M.A., Blow, F.C., & Booth, B.M. (2000). A comparison of substance abuse patients’ and 

counselors’ perceptions of relapse risk: Relationship to actual relapse. Journal of Substance 

Abuse Treatment, 19(2):161-169. 

Wild, T.C., Newton-Taylor, B., et al. (2001). Attitudes toward compulsory substance abuse 

treatment: A comparison of the public, counselors, probationers and judges’ views. 

Drugs: Education, Prevention & Policy, 8(1):33-45.
166

Recovery Bibliography

In substance use disorders treatment, much attention is paid to what happens during acute

episodes of treatment. There is often significant emphasis on treatment issues, such as 

treatment approach, therapeutic alliance, client retention, family involvement, cultural 

competency, and pharmacological intervention. The importance of the ongoing recovery 

process is sometimes not given sufficient attention. It is crucial to identify and address clients’ 

needs for case management, continuing care, housing, employment, transportation, education, 

life skills, social support—all the things that help clients reintegrate into the community, 

build a meaningful life, and sustain their recovery.

Blume, S. (1977). Role of the recovered alcoholic in the treatment of alcoholism. In B. Kissin & 

H. Begliester (Eds.) The Biology of Alcoholism, Volume 5: Treatment and Rehabilitation of 

the Chronic Alcoholic. New York: Plenum Press, 545-565.

Bond, J., Kaskutas, L., & Weisner, C. (2003). The persistent influence of social networks and 

Alcoholics Anonymous on abstinence. Journal of Studies on Alcohol, 64(4):579-588.

Borkman, T. (1998). Is recovery planning any different from treatment planning? Journal of 

Substance Abuse Treatment, 15(1):37-42. 

Boyle, M.G., White, W.L., et al. Behavioral Health Recovery Management: A Statement of 

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Broome, M., Simpson, D.D., & Joe, G.W. (2002). The role of social support following short-term 

inpatient treatment. Journal on Addictions, 11(1):57-65.

Cloud, W., & Granfield, R. (2001). Natural recovery from substance dependency: Lessons for 

treatment providers. Journal of Social Work Practice in the Addictions, 1(1):83-104.

Coyhis, D., & White, W. (2002). Addiction and recovery in Native America: Lost history, 

enduring lessons. Counselor, 3(5):16-20.

Dennis, M., Scott, C.K., & Funk, R. (2003). An experimental evaluation of recovery management 

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model. Psychiatric Services, 52(11):1462-1468.

Galanter, M. (2002). Healing through social and spiritual affiliation. Psychiatric Services, 

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Granfield, R., & Cloud, W. (2001). Social capital and natural recovery: The role of social 

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Gregoire, T.K., & Snively, C.A. (2001). The relationship of social support and economic selfsufficiency to substance abuse outcomes in a long-term recovery program for women. 

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Humphreys, K. (2004). Circles of Recovery: Self-Help Organizations for Addictions. New York: 

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strategies for reducing the risk of relapse. Drugs: Education, Prevention & Policy, 7(2):

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dependency: A transpersonal perspective. Families in Society: the Journal of Contemporary 

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communities. Journal of Psychoactive Drugs, 35(1):1-5.

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169

Section 4:

Appendices

u

u 

u 

u 

u 

Appendix A – Glossary

Appendix B – The Competencies

Appendix C – National Validation Study

Appendix D – Complete Bibliography

Appendix E – Other Contributors
170

Addiction Counseling Competencies

Appendix A – Glossary

This glossary contains descriptions of key words used in this Technical Assistance Publication. 

The descriptions of the terms reflect the usage of the terms in this document. The descriptions 

are not intended as universal or complete definitions of the terms.

Active listening – a counseling skill that enhances rapport and demonstrates interest and 

understanding through the use of verbal and nonverbal acknowledgment of client statements.

Addiction – a chronic, relapsing disease of the brain with social and behavioral manifestations 

marked by continued alcohol or drug use despite negative consequences.

Addiction counseling – professional and ethical application of specific competencies that 

constitute eight practice dimensions, including clinical evaluation; treatment planning; referral; 

service coordination; individual, group, and family counseling; client, family, and community 

education; and documentation.

Advocacy – (1) a social or political movement working for changes in legislation, policy, 

and funding to reflect clients’ concerns and protect their rights (i.e., advocacy for clients); 

(2) a philosophy of substance abuse treatment practice maintaining that clients should be 

involved actively in their own treatment and have rights in its planning and implementation 

(i.e., advocacy by clients). Much of advocacy is about shifting the system from the directive 

model to one in which the client is an empowered, involved participant in treatment decisions. 

Biomedical – pertaining to the biological and physiological aspects of clinical medicine.

Biopsychosocial – the biological, psychosocial, and social influences in human development 

and behavior.

Case management – see “Service coordination.”

Client – individual, significant other, or community agent who presents for alcohol and drug 

abuse education, prevention, intervention, treatment, and consultation services.

Collateral sources – persons or organizations providing pertinent information about a client 

(can include family members and legal, educational, and medical personnel).

Competency – specific counselor functions comprising requisite knowledge, skills, and 

attitudes.

Confidentiality – a client’s right to privacy as defined by applicable Federal and State statutes.

Confidentiality rules and regulations – rules established by Federal and State agencies to 

limit disclosure of information about a client’s substance use disorder and treatment (described 

in 42 CFR, Part 2B 16). Programs must notify clients of their rights to confidentiality, provide a 

written summary of these rights, and establish written procedures regulating access to and use 

of client records.

Confrontation – a form of interpersonal exchange in which individuals present to one another 

their observations of, and reactions to, behaviors and attitudes that are matters of concern. 

Feedback is provided on behavior, and an appeal is made to the client for personal honesty, 

truthfulness in dealing with others, and responsible behavior.

Content – the subjects discussed in the context of counseling.
171

Continuing care – care that supports a client’s progress, monitors his or her condition, 

and responds to a return to substance use or a return of mental disorder symptoms. It is both 

a process of posttreatment monitoring and a form of treatment itself; sometimes referred to 

as aftercare.

Continuum of care – the array of services that differ in terms of unique needs of clients 

throughout the course of treatment and recovery.

Contracting – the process by which the client and the counselor enter into an agreement to 

address specific problems, issues, or behaviors.

Co-occurring disorder/coexisting disorder – the presence of concurrent psychiatric or 

medical disorders in combination with a substance use disorder.

Counseling – a therapeutic process aimed at meeting specific identified needs of the client.

Countertransference – a counselor’s unresolved feelings for significant others that may be 

transferred to the client.

Craving – an urgent, seemingly overpowering desire to use a substance, which often is 

associated with tension, anxiety, or other dysphoric, depressive, or negative affective states.

Cultural competency – the capacity of a service provider or organization to understand and 

work effectively in accord with the beliefs and practices of persons from a given ethnic/racial/

religious/social group or sexual orientation. It includes the holding of knowledge, skills, and 

attitudes that allow the treatment provider and program to understand the full context of a 

client’s current and past socioenvironmental situation.

Cultural diversity – the vast array of different cultural groups based on varying behaviors, 

attitudes, values, languages, celebrations, rituals, and histories.

Culture – the vast structure of behaviors, ideas, attitudes, values, habits, beliefs, customs, 

language, rituals, ceremonies, histories, and practices distinctive to a particular group of people.

Diagnosis – classification of the nature and severity of the substance use, medical, mental 

health, or other problems present. DSM-IV-TR and ICD-10 commonly are used to classify 

substance use and mental disorders.

Disorder – an affliction that affects the functions of the mind and/or body, disturbing physical 

and/or mental health.

Duty to warn – the legal obligation of a counselor (healthcare provider) to notify the 

appropriate authorities as defined by statute and/or the potential victim when there is serious 

danger of a client’s inflicting injury on an identified individual.

Efficacy – the power to produce a desired effect.

Elements – specific, definable areas found in three of the practice dimensions (clinical 

evaluation, service coordination, and counseling).

Empirical – relying on observation or experience rather than theoretical principles or theory.

Engagement – a client’s commitment to and maintenance of treatment in all of its forms. 

A successful engagement program helps clients view the treatment facility as an important 

resource.

Appendix A – Glossary
172

Addiction Counseling Competencies

Epidemiology – the study of the incidence, distribution, and consequences of a particular 

problem in one or more populations.

Etiology – the study of origins (what causes a disorder).

Extrinsic motivator – a rationale for changing substance use that comes from outside the 

client. Examples include threat of losing a job, legal charges, or a spouse/significant other 

ending a relationship.

Harmful use – patterns of alcohol or drug use for nonmedical reasons that result in negative 

health consequences and some degree of impairment in social, psychological, and occupational 

functioning for the user.

Helping strategy – an activity employed by the counselor to help the client accomplish his or

her therapeutic goals.

Hepatitis C – a viral disease of the liver that is a major cause of liver damage and cirrhosis.

Incidence – the number of new cases of a disorder that occur in a population during a specific 

period.

Indicated preventive interventions – strategies designed for persons who are identified as 

having minimal but detectable signs or symptoms or precursors of some illness or condition, 

but whose condition is below the threshold of a formal diagnosis of the condition.

Individualized treatment plan – a strategy that addresses the identified substance use 

disorder(s), as well as issues related to treatment progress, including relationships with family 

and significant others, employment, education, spirituality, health concerns, and legal needs. 

Plans are developed in collaboration with the client and significant others and tailored to fit the 

client’s unique biopsychosocial strengths and needs. 

Infectious – a contagious illness or disease transmitted by direct or indirect contact.

Initiation – the individual’s introduction to and onset of alcohol or drug use.

Intervention – the specific treatment strategies, therapies, or techniques that are used to treat 

one or more disorders.

Intoxication – an altered physical and mental state resulting from the overuse of alcohol 

or drugs.

Intrinsic motivator – an individual’s internal reason for changing substance use behaviors, 

such as poor health or low self-esteem, resulting from his or her substance use.

Life skills training – activities that include development of job, vocational, life (budgeting, 

leisure, etc.), anger management, general coping, communication, and social skills; literacy 

classes and GED preparation; parenting classes; and relationship building. 

Managed care – an approach to delivery of health and mental health services that seeks to 

reduce the cost of care by monitoring the access to and use of medical services and supplies, 

as well as outcomes of that care.

Modality/treatment modality – any specific treatment method or procedure used to relieve 

symptoms or motivate behaviors that lead to recovery.

Model – a collection of beliefs or unifying theory about what is needed to bring about change 

with a particular client in a particular treatment context.
173

Motivational interviewing – a direct, client-centered counseling style implemented to elicit 

behavior change by helping clients resolve their ambivalence to change.

Multiaxial diagnostic criteria – the system used by the DSM-IV-TR that evaluates the acute, 

longstanding medical conditions as well as stressors and level of functioning (current and past).

Multidisciplinary approach – a planned and coordinated program of care involving two or 

more health professions for the purpose of improving health care as a result of their joint 

contributions.

Multidisciplinary assessment approach – an organized process by which professionals of 

different specialties collaborate to assess the needs of the client.

Mutual help – a process present in many self-help groups by which the members of such 

groups rely on and receive support from other members who share the same condition.

Outcome monitoring – collection and analysis of data during and following alcohol and drug 

treatment to determine the effects of treatment, especially in relation to improvements in client 

functioning.

Outcome statement – an agreement between the client and the counselor that identifies the 

desired results of treatment. 

Outreach strategies – approaches that actively seek out persons in a community who have 

substance use disorders and engage them in substance abuse treatment.

Patient – see “Client.”

Peer counselor – individuals in recovery from substance use disorders who have been trained 

to work in substance abuse treatment settings.

Practice dimensions – the eight essential areas of practice that addiction counselors must 

master to effectively provide treatment activities identified in The Competencies.

Prevalence – the percentage of people in the population that has a specific disorder.

Prevention – the theory and means for reducing the harmful effects of drug use in specific 

populations. Prevention objectives are to protect individuals before they manifest signs or 

symptoms of substance use problems, identify persons in the early stages of substance abuse 

and intervene, and end compulsive use of psychoactive substances through treatment.

Problem statement – a statement that describes a client’s current condition in behavioral terms.

Process – the way in which a client, counselor, or group engages or interacts.

Professionalism – a demonstration of knowledge, skills, and attitudes consistently applied 

when working with people who use substances and abiding by a code of ethics most commonly 

held by addiction professionals.

Projective identification – the process by which a person places internal negative feelings or 

concepts about oneself onto others.

Protective factors – conditions that promote bonding to prosocial values and institutions and 

can serve to buffer the negative effects of risks.

Psychoactive substance – a pharmacological agent that can change mood, behavior, and 

cognition process.

Rapport – the degree to which trust and openness are present in the relationship between 

counselor and client; an essential element of the therapeutic relationship.

Appendix A – Glossary
174

Addiction Counseling Competencies

Recovery – achieving and sustaining a state of health in which the individual no longer engages 

in problem behavior or psychoactive substance use and is able to establish a lifestyle that 

embraces health and positive goals.

Regression – a mechanism whereby an individual retreats to the use of early-life or less mature 

responses in attempting to cope with stress, fears, pain, or memories.

Relapse – the return to a pattern of substance abuse or the process during which indicators 

appear before the client’s resumption of substance use.

Relapse prevention – a variety of interventions designed to teach people with substance use 

disorders to cope more effectively and to overcome the stressors/triggers in their environments 

that may lead them back into drug use and dependence. The interventions can be placed in five 

categories: assessment procedures, insight/awareness raising techniques, coping skills training, 

cognitive strategies, and lifestyle modification.

Reliability – the degree to which a measure is consistent.

Resilience – the ability of an individual to cope with or overcome the negative effects of risk 

factors or to “bounce back” from a problem. This capability develops and changes over time, 

is enhanced by protective factors, and contributes to the maintenance or enhancement of health.

Risk factors – conditions for a group, individual, or identified geographic area that increase the 

likelihood of a substance use problem or substance abuse.

Screening – gathering and sorting of information used to determine whether an individual has 

a problem with substance use and, if so, whether a detailed clinical assessment is appropriate. 

Selective preventive interventions – activities targeted to individuals or a subgroup of the 

population whose risk of developing a disorder is significantly higher than average.

Self-determination – the extent to which individuals control their lives.

Self-help group – a supportive, educational, usually change-oriented mutual-help group that 

addresses a single life problem or condition shared by all members.

Service coordination – the process of prioritizing, managing, and implementing activities in an 

individual’s treatment plan.

Significant others – family member, sexual partner, and others on whom an individual is 

dependent for meeting all or part of his or her needs.

Sobriety – the quality or condition of abstinence from psychoactive substance abuse supported 

by personal responsibility in recovery.

Special populations – diverse groups of individuals sharing a particular characteristic, 

circumstance, or problem.

Spirituality – a belief system that acknowledges and appreciates the influence in one’s life of a 

higher power or state of being.

Stage of change – transtheoretical description of one of several stages through which a person 

passes in moving from active use to treatment and abstinence.

Stage of readiness – the individual’s awareness of need to change. Can be influenced by 

external pressure (family, legal system, or employer) or internal pressure (physical health 

concerns).
175

Substance abuse – a maladaptive pattern of substance use leading to clinically significant 

impairment or distress such as failure to fulfill major role responsibilities or use in spite of 

physical hazards, legal problems, or interpersonal and social problems. (See also DSM-IV-TR 

for specific criteria.)

Substance dependence – the need for alcohol or a drugs that results from the use of that 

substance. This need includes both mental and physical changes that make it difficult for 

individuals to control when they use the substance and how much they use. Psychological 

dependence occurs when individuals need the substance to feel good or normal or to 

function. Physical dependence occurs when the body adapts to the substance and needs 

increasing amounts to achieve the same effect or to function. (See also DSM-IV-TR for 

specific criteria.)

Substance use – consumption of low and/or infrequent doses of alcohol or drugs, sometimes 

called “experimental,” “casual,” “recreational,” or “social” use, such that consequences may be 

rare or minor.

Systems theory – view of behavior as an interactive part of a larger social structure.

Theory – a framework to organize and integrate knowledge to facilitate answering the question, 

“why?”

Transdisciplinary – knowledge and attitudes that both transcend and are needed by all 

disciplines working with persons with substance use disorders.

Transference – the process in which a client’s strong feelings for significant others may be 

transferred to the counselor.

Treatment barriers – anything that hinders treatment. Examples include financial problems, 

language difficulties, ethnic and social attitudes, logistics (e.g., child care, transportation), 

and unhelpful patient behaviors (e.g., tardiness, missed appointments).

Treatment goals – objectives based on resolving problems identified during assessment and 

reasonably achievable in the active treatment phase.

Treatment interventions – strategies the counselor and other professionals use to assist the 

client in achieving treatment goals. 

Treatment objectives – incremental steps a client takes in achieving treatment goals.

Universal prevention – prevention designed for everyone in the eligible population, both the 

general public and all members of specific eligible groups. Also, activities targeted to the general 

public or a whole population group that has not been identified on the basis of individual risk.

Validity – the degree to which an instrument or process measures what it is designed to measure.

Appendix A – Glossary
176

Addiction Counseling Competencies

Appendix B – The Competencies:

A Complete List

This is a complete list of the competencies without the knowledge, skills, and attitudes.

Transdisciplinary Foundation I: Understanding Addiction

Competency 1:

Understand a variety of models and theories of addiction and other problems related to 

substance use.

Competency 2:

Recognize the social, political, economic, and cultural context within which addiction and 

substance abuse exist, including risk and resiliency factors that characterize individuals and 

groups and their living environments. 

Competency 3:

Describe the behavioral, psychological, physical health, and social effects of psychoactive 

substances on the person using and significant others.

Competency 4:

Recognize the potential for substance use disorders to mimic a variety of medical and mental 

health conditions and the potential for medical and mental health conditions to coexist with 

addiction and substance abuse.

Transdisciplinary Foundation II: Treatment Knowledge

Competency 5:

Describe the philosophies, practices, policies, and outcomes of the most generally accepted and 

scientifically supported models of treatment, recovery, relapse prevention, and continuing care 

for addiction and other substance-related problems.

Competency 6:

Recognize the importance of family, social networks, and community systems in the treatment 

and recovery process.

Competency 7:

Understand the importance of research and outcome data and their application in clinical 

practice.

Competency 8:

Understand the value of an interdisciplinary approach to addiction treatment.
177

Transdisciplinary Foundation III: Application to Practice

Competency 9:

Understand the established diagnostic criteria for substance use disorders, and describe 

treatment modalities and placement criteria within the continuum of care.

Competency 10:

Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, 

and dependence.

Competency 11:

Tailor helping strategies and treatment modalities to the client’s stage of dependence, change, 

or recovery.

Competency 12:

Provide treatment services appropriate to the personal and cultural identity and language of 

the client.

Competency 13:

Adapt practice to the range of treatment settings and modalities.

Competency 14:

Be familiar with medical and pharmacological resources in the treatment of substance use 

disorders.

Competency 15:

Understand the variety of insurance and health maintenance options available and the 

importance of helping clients access those benefits.

Competency 16:

Recognize that crisis may indicate an underlying substance use disorder and may be a window 

of opportunity for change.

Competency 17:

Understand the need for and use of methods for measuring treatment outcome.

Transdisciplinary Foundation IV: Professional Readiness

Competency 18:

Understand diverse cultures, and incorporate the relevant needs of culturally diverse groups, 

as well as people with disabilities, into clinical practice.

Competency 19:

Understand the importance of self-awareness in one’s personal, professional, and cultural life.

Competency 20:

Understand the addiction professional’s obligations to adhere to ethical and behavioral 

standards of conduct in the helping relationship.

Appendix B – The Competencies
178

Addiction Counseling Competencies

Competency 21:

Understand the importance of ongoing supervision and continuing education in the delivery 

of client services.

Competency 22:

Understand the obligation of the addiction professional to participate in prevention and 

treatment activities.

Competency 23:

Understand and apply setting-specific policies and procedures for handling crisis or dangerous 

situations, including safety measures for clients and staff.

Practice Dimension I: Clinical Evaluation

Element: Screening

Competency 24:

Establish rapport, including management of a crisis situation and determination of need for 

additional professional assistance.

Competency 25:

Gather data systematically from the client and other available collateral sources, using screening instruments and other methods that are sensitive to age, developmental level, culture, and 

gender. At a minimum, data should include current and historic substance use; health, mental 

health, and substance-related treatment histories; mental and functional statuses; and current 

social, environmental, and/or economic constraints.

Competency 26:

Screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms; 

aggression or danger to others; potential for self-inflicted harm or suicide; and co-occurring 

mental disorders.

Competency 27:

Assist the client in identifying the effect of substance use on his or her current life problems 

and the effects of continued harmful use or abuse.

Competency 28:

Determine the client’s readiness for treatment and change as well as the needs of others 

involved in the current situation.

Competency 29:

Review the treatment options that are appropriate for the client’s needs, characteristics, goals, 

and financial resources.

Competency 30:

Apply accepted criteria for diagnosis of substance use disorders in making treatment 

recommendations.
179

Competency 31:

Construct with the client and appropriate others an initial action plan based on client needs, 

client preferences, and resources available.

Competency 32:

Based on the initial action plan, take specific steps to initiate an admission or referral and 

ensure followthrough. 

Practice Dimension I: Clinical Evaluation

Element: Assessment

Competency 33:

Select and use a comprehensive assessment process that is sensitive to age, gender, racial and 

ethnic culture, and disabilities that includes but is not limited to:

X History of alcohol and drug use

X Physical health, mental health, and addiction treatment histories

X Family issues

X Work history and career issues

X History of criminality

X Psychological, emotional, and worldview concerns

X Current status of physical health, mental health, and substance use

X Spiritual concerns of the client

X Education and basic life skills

X Socioeconomic characteristics, lifestyle, and current legal status

X Use of community resources

X Treatment readiness

X Level of cognitive and behavioral functioning.

Competency 34:

Analyze and interpret the data to determine treatment recommendations. 

Competency 35:

Seek appropriate supervision and consultation.

Competency 36:

Document assessment findings and treatment recommendations.

Practice Dimension II: Treatment Planning

Competency 37:

Use relevant assessment information to guide the treatment planning process.

Appendix B – The Competencies
180

Addiction Counseling Competencies

Competency 38:

Explain assessment findings to the client and significant others.

Competency 39:

Provide the client and significant others with clarification and additional information as needed.

Competency 40:

Examine treatment options in collaboration with the client and significant others.

Competency 41:

Consider the readiness of the client and significant others to participate in treatment.

Competency 42:

Prioritize the client’s needs in the order they will be addressed in treatment.

Competency 43:

Formulate mutually agreed-on and measurable treatment goals and objectives.

Competency 44:

Identify appropriate strategies for each treatment goal.

Competency 45:

Coordinate treatment activities and community resources in a manner consistent with the 

client’s diagnosis and existing placement criteria.

Competency 46:

Develop with the client a mutually acceptable treatment plan and method for monitoring and 

evaluating progress.

Competency 47:

Inform the client of confidentiality rights, program procedures that safeguard them, and the 

exceptions imposed by regulations.

Competency 48:

Reassess the treatment plan at regular intervals or when indicated by changing circumstances.

Practice Dimension III: Referral

Competency 49:

Establish and maintain relationships with civic groups, agencies, other professionals, 

governmental entities, and the community at large to ensure appropriate referrals, identify 

service gaps, expand community resources, and help address unmet needs.

Competency 50:

Continuously assess and evaluate referral resources to determine their appropriateness.

Competency 51:

Differentiate between situations in which it is most appropriate for the client to self-refer to a 

resource and situations requiring counselor referral.
181

Competency 52:

Arrange referrals to other professionals, agencies, community programs, or appropriate 

resources to meet the client’s needs.

Competency 53:

Explain in clear and specific language the necessity for and process of referral to increase the 

likelihood of client understanding and followthrough.

Competency 54:

Exchange relevant information with the agency or professional to whom the referral is being 

made in a manner consistent with confidentiality rules and regulations and generally accepted 

professional standards of care.

Competency 55:

Evaluate the outcome of the referral.

Practice Dimension IV: Service Coordination

Element: Implementing the Treatment Plan

Competency 56:

Initiate collaboration with the referral source.

Competency 57:

Obtain, review, and interpret all relevant screening, assessment, and initial treatment planning 

information.

Competency 58:

Confirm the client’s eligibility for admission and continued readiness for treatment and change.

Competency 59:

Complete necessary administrative procedures for admission to treatment.

Competency 60:

Establish accurate treatment and recovery expectations with the client and involved significant 

others, including but not limited to:

X The nature of services

X Program goals

X Program procedures

X Rules regarding client conduct

X The schedule of treatment activities

X Costs of treatment

X Factors affecting duration of care

X Clients’ rights and responsibilities

X The effect of treatment and recovery on significant others.

Appendix B – The Competencies
182

Addiction Counseling Competencies

Competency 61:

Coordinate all treatment activities with services provided to the client by other resources.

Practice Dimension IV: Service Coordination

Element: Consulting

Competency 62:

Summarize the client’s personal and cultural background, treatment plan, recovery progress, 

and problems inhibiting progress to ensure quality of care, gain feedback, and plan changes in 

the course of treatment.

Competency 63:

Understand the terminology, procedures, and roles of other disciplines related to the treatment 

of substance use disorders.

Competency 64:

Contribute as part of a multidisciplinary treatment team. 

Competency 65:

Apply confidentiality rules and regulations appropriately.

Competency 66:

Demonstrate respect and nonjudgmental attitudes toward clients in all contacts with 

community professionals and agencies.

Practice Dimension IV: Service Coordination

Element: Continuing Assessment and Treatment Planning

Competency 67:

Maintain ongoing contact with the client and involved significant others to ensure adherence 

to the treatment plan.

Competency 68:

Understand and recognize stages of change and other signs of treatment progress.

Competency 69:

Assess treatment and recovery progress, and, in consultation with the client and significant 

others, make appropriate changes to the treatment plan to ensure progress toward 

treatment goals.

Competency 70:

Describe and document the treatment process, progress, and outcome.

Competency 71:

Use accepted treatment outcome measures.
183

Competency 72:

Conduct continuing care, relapse prevention, and discharge planning with the client and 

involved significant others.

Competency 73:

Document service coordination activities throughout the continuum of care.

Competency 74:

Apply placement, continued stay, and discharge criteria for each modality on the continuum 

of care.

Practice Dimension V: Counseling

Element: Individual Counseling

Competency 75:

Establish a helping relationship with the client characterized by warmth, respect, genuineness, 

concreteness, and empathy.

Competency 76:

Facilitate the client’s engagement in the treatment and recovery process.

Competency 77:

Work with the client to establish realistic, achievable goals consistent with achieving and 

maintaining recovery.

Competency 78:

Promote client knowledge, skills, and attitudes that contribute to a positive change in substance 

use behaviors.

Competency 79:

Encourage and reinforce client actions determined to be beneficial in progressing toward 

treatment goals.

Competency 80:

Work appropriately with the client to recognize and discourage all behaviors inconsistent with 

progress toward treatment goals.

Competency 81:

Recognize how, when, and why to involve the client’s significant others in enhancing or 

supporting the treatment plan.

Competency 82:

Promote client knowledge, skills, and attitudes consistent with the maintenance of health and 

prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, hepatitis C, and other 

infectious diseases.

Competency 83:

Facilitate the development of basic and life skills associated with recovery.

Appendix B – The Competencies
184

Addiction Counseling Competencies

Competency 84:

Adapt counseling strategies to the individual characteristics of the client, including but not 

limited to disability, gender, sexual orientation, developmental level, culture, ethnicity, age, 

and health status.

Competency 85:

Make constructive therapeutic responses when the client’s behavior is inconsistent with stated 

recovery goals.

Competency 86:

Apply crisis prevention and management skills.

Competency 87:

Facilitate the client’s identification, selection, and practice of strategies that help sustain the 

knowledge, skills, and attitudes needed for maintaining treatment progress and preventing 

relapse.

Practice Dimension V: Counseling

Element: Group Counseling

Competency 88:

Describe, select, and appropriately use strategies from accepted and culturally appropriate 

models for group counseling with clients with substance use disorders.

Competency 89:

Carry out the actions necessary to form a group, including but not limited to determining group 

type, purpose, size, and leadership; recruiting and selecting members; establishing group goals 

and clarifying behavioral ground rules for participating; identifying outcomes; and determining 

criteria and methods for termination or graduation from the group.

Competency 90:

Facilitate the entry of new members and the transition of exiting members.

Competency 91:

Facilitate group growth within the established ground rules and movement toward group and 

individual goals by using methods consistent with group type.

Competency 92:

Understand the concepts of process and content, and shift the focus of the group when such a 

shift will help the group move toward its goals.

Competency 93:

Describe and summarize the client’s behavior within the group to document the client’s 

progress and identify needs and issues that may require a modification in the treatment plan.
185

Practice Dimension V: Counseling

Element: Counseling Families, Couples, and Significant Others

Competency 94:

Understand the characteristics and dynamics of families, couples, and significant others affected 

by substance use.

Competency 95:

Be familiar with and appropriately use models of diagnosis and intervention for families, 

couples, and significant others, including extended, kinship, or tribal family structures.

Competency 96:

Facilitate the engagement of selected members of the family or significant others in the 

treatment and recovery process.

Competency 97:

Assist families, couples, and significant others in understanding the interaction between the 

family system and substance use behaviors.

Competency 98:

Assist families, couples, and significant others in adopting strategies and behaviors that sustain 

recovery and maintain healthy relationships.

Practice Dimension VI: Client, Family, and Community Education

Competency 99:

Provide culturally relevant formal and informal education programs that raise awareness and 

support substance abuse prevention and the recovery process.

Competency 100:

Describe factors that increase the likelihood for an individual, community, or group to be at risk 

for, or resilient to, psychoactive substance use disorders.

Competency 101:

Sensitize others to issues of cultural identity, ethnic background, age, and gender in prevention, treatment, and recovery.

Competency 102:

Describe warning signs, symptoms, and the course of substance use disorders.

Competency 103:

Describe how substance use disorders affect families and concerned others.

Competency 104:

Describe the continuum of care and resources available to the family and concerned others.

Appendix B – The Competencies
186

Addiction Counseling Competencies

Competency 105:

Describe principles and philosophy of prevention, treatment, and recovery.

Competency 106:

Understand and describe the health and behavior problems related to substance use, 

including transmission and prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, 

hepatitis C, and other infectious diseases.

Competency 107:

Teach life skills, including but not limited to stress management, relaxation, communication, 

assertiveness, and refusal skills.

Practice Dimension VII: Documentation

Competency 108:

Demonstrate knowledge of accepted principles of client record management.

Competency 109:

Protect client rights to privacy and confidentiality in the preparation and handling of records, 

especially in relation to the communication of client information with third parties.

Competency 110:

Prepare accurate and concise screening, intake, and assessment reports.

Competency 111:

Record treatment and continuing care plans that are consistent with agency standards and 

comply with applicable administrative rules.

Competency 112:

Record progress of client in relation to treatment goals and objectives.

Competency 113:

Prepare accurate and concise discharge summaries.

Competency 114:

Document treatment outcome, using accepted methods and instruments.

Practice Dimension VIII: Professional and Ethical Responsibilities

Competency 115:

Adhere to established professional codes of ethics that define the professional context within 

which the counselor works to maintain professional standards and safeguard the client.

Competency 116:

Adhere to Federal and State laws and agency regulations regarding the treatment of substance 

use disorders. 
187

Competency 117:

Interpret and apply information from current counseling and psychoactive substance use 

research literature to improve client care and enhance professional growth.

Competency 118:

Recognize the importance of individual differences that influence client behavior, and apply this 

understanding to clinical practice.

Competency 119:

Use a range of supervisory options to process personal feelings and concerns about clients.

Competency 120:

Conduct self-evaluations of professional performance applying ethical, legal, and professional 

standards to enhance self-awareness and performance.

Competency 121:

Obtain appropriate continuing professional education.

Competency 122:

Participate in ongoing supervision and consultation.

Competency 123:

Develop and use strategies to maintain one’s physical and mental health.

Appendix B – The Competencies
188

Addiction Counseling Competencies

Appendix C – National Validation Study:

Defining and Measuring the

Competence of Addiction Counselors

Paula K. Horvatich, Ph.D., and Jon F. Wergin, Ph.D.

Virginia Commonwealth University1

Introduction

The education of addiction counselors, once based on tradition, myth, and politics, is becoming 

increasingly professionalized, based on competencies, research, and best practice (Fisher 1997). 

Treatment for psychoactive substance abuse and dependence has traditionally been provided 

by addiction counselors. Although many counselors have academic degrees, many others have 

become counselors following personal experiences with treatment and recovery (Deitch & 

Carleton 1997). Formal education for addiction counselors has traditionally consisted of 

specialty training provided by treatment agencies, professional or certification organizations, 

or human service programs of community colleges that confer associate’s degrees. Certification 

of addiction counselors varies from State to State but usually requires a high school diploma 

and a specified number of years of experience in the field. A bachelor’s degree is required in 

only some States. In others, addiction counselors require no certification as long as they work 

in a State-approved facility.

Because of a variety of policy and economic factors, training requirements for certification in 

addiction counseling have become more rigorous. These factors include, among others, the 

pervasiveness and effect of substance abuse on society, expanded treatment research efforts, 

and managed behavioral health care. If substance use problems were not so widespread and 

costly to society, there would be less interest in the credentials of addiction counselors and the 

outcomes of the treatment they provide. 

Although treatment research has grown rapidly and has provided useful insights, new information will be useless unless it is implemented by frontline practitioners. Addiction counselors 

must be able to understand and apply new knowledge, but traditionally these connections have 

not been made (Fisher 1997).

Efforts to make treatment more efficient have resulted in the integration of substance abuse 

treatment with mental health services, thereby increasing the role of mental health and other 

healthcare professionals in substance abuse treatment. Addiction specialties have emerged 

in medicine, nursing, social work, psychology, and counseling, including rehabilitation 

counseling. Managed care has made it increasingly likely that master’s-level addiction 

1 An earlier version of this paper was presented at the American Educational Research Association Annual Meeting,

 April 13–17, 1998, in San Diego, California. This study was funded by the Substance Abuse and Mental Health 

 Services Administration’s Center for Substance Abuse Treatment Grant Number 5U98 TI 00837. The original

 version is archived on the Education Resources Information Center (ERIC) Web site (http://www.eric.ed.gov) under 

 ERIC document number ED422545.
189

counselors will be reimbursed for services provided. Addiction counselors who are currently 

certified with only a high school diploma may have difficulty making the leap to a master’s 

degree. Many addiction counselors may not be able to obtain the advanced education needed 

fast enough to survive in the market. 

In 1993 the Center for Substance Abuse Treatment (CSAT) created the Addiction Technology 

Transfer Center (ATTC) Program to foster improvements in the preparation of addiction 

treatment professionals (Rohrer et al. 1996). As part of the ATTC Program, a National 

Curriculum Committee (the Committee) was established to evaluate existing curricula and to 

set priorities for current academic programs. At its first meeting, the Committee realized that 

the field had not defined the knowledge, skills, and attitudes that should be shared by all 

addiction counselors. Identifying and delineating these competencies became the Committee’s 

first task to professionalize the field.

Representing a range of specialties within the substance abuse treatment field, members of the 

Committee provided practice-related information through a brainstorming process. Once the 

general responsibilities of the field were identified, the Committee developed task statements 

for each. Committee members ordered the responsibilities and task statements in a learning 

sequence, based on the order in which responsibilities are generally performed on the job. 

The process of identifying responsibilities was considered complete when the Committee 

reached consensus regarding the accuracy and sequence of the task statements produced. 

The Committee identified four transdisciplinary foundations and eight practice dimensions 

encompassing 121 competencies. These results are consistent with the DACUM (Develop a 

Curriculum) process (Norton 1985), which typically results in 8 to 12 responsibilities and 50 

to 200 tasks. The four transdisciplinary foundation categories were understanding addiction, 

treatment knowledge, application to practice, and professional readiness. The eight practice 

dimension categories were clinical evaluation; treatment planning; referral; case management; 

counseling; client, family, and community education; documentation; and professional and 

ethical responsibilities. Each category had between 3 and 20 competencies in it. This effort 

resulted in the publication of Addiction Counselor Competencies (Addiction Technology 

Transfer Centers 1995).

Although the Committee incorporated existing literature related to the work of addiction 

counselors, particularly the practice analysis conducted by Birch and Davis Corporation (1986) 

and the International Certification and Reciprocity Consortium Role Delineation Study 

(International Certification and Reciprocity Commission/Alcohol and Other Drug Abuse 1991) 

when developing the competencies that made up Addiction Counselor Competencies, it also 

relied on its own contributions. The Committee felt that job-related data provided a snapshot of 

what is, not what could be. And in the addiction counseling field, what is has been questioned. 

Because of its peer counselor and personal experience history, treatment provided by some 

addiction counselors has been described as narrow and inflexible, impeding the adoption of 

new treatment methods that may better meet the needs of clients. Moreover, lacking traditional 

academic preparation, some counselors have difficulty understanding literature and 

incorporating new research results. Consequently, the Committee’s work emphasized moving 

the field forward. To gauge the potential value of the competencies, the Committee conducted 

a study to determine which of 121 competencies were perceived as necessary for practice by 

addiction counselors in the field.

Appendix C – National Validation Study
190

Addiction Counseling Competencies

Method

The purposes of this study were the following: 

X Validate a set of 121 competencies for the profession of addiction counseling 

X Determine gaps between actual and needed competencies displayed by entry-level 

counselors 

X Determine congruence among the perceptions of three practitioner groups. 

The study was conducted in partnership with the ATTCs, CSAT, and the Northwest Regional 

Educational Laboratory (Adams & Gallon 1997).

A survey was conducted in 16 States and Puerto Rico from November 1996 to January 1997. 

The survey instrument was distributed through the ATTCs to State-approved substance abuse 

treatment agencies. State authorities worked with ATTCs to select qualified treatment sites, 

distribute the surveys with appropriate cover letters from the State authority, and implement 

followup strategies to ensure an adequate return rate.

A random sample of 60 State-approved treatment facilities was selected in each participating 

State. For States with fewer than 60 qualifying facilities, all State-approved treatment facilities 

were included in the study, if the facilities were large enough to have a separate clinical 

supervisor who was not also an administrator in the facility.

Each treatment agency director was sent a cover letter and instructions, three copies of the 

16-page survey listing 121 competencies, and corresponding postage-paid return envelopes. 

Directors were asked to distribute the surveys to a clinical supervisor, a least experienced 

counselor, and a most proficient counselor. “Least experienced” was defined as nonsupervisory, 

direct-care counselors having no more than 3 years of paid experience as an addiction treatment professional. Each respondent rated the level of proficiency “typically demonstrated” by 

entry-level counselors at the time of hire, as well as the level of competency “needed” at the 

time of hire. Each respondent was instructed to provide a rating for each item on a five-point 

scale, ranging from 1 (“very little to no knowledge/skill/attitude”) to 5 (“excellent knowledge/

skill/attitude”). Beginning 1 week following the due date of the responses, telephone calls were 

placed with nonresponding agencies, encouraging them to submit finished surveys. Final response rates varied by State, ranging from 25 percent in North Carolina to 82 percent in Maryland; the response rate nationally was 46 percent. The total number of respondents was 1,238. 

Results

Demographics. (See exhibits 1–6.) Respondents included 369 least experienced counselors, 

412 most proficient counselors, and 457 clinical supervisors (N=1,238). Females outnumbered 

males in all respondent groups. The sample was mostly middle-aged, and age increased with 

level of experience. Seventy-five percent of the respondents were Caucasian, 14 percent African 

American, 7 percent Hispanic, and 4 percent filled other minority categories or were undeclared. 

The respondents were well educated with 74 percent reporting bachelor’s or master’s degrees. 

As expected, clinical supervisors reported the greatest number of graduate degrees. Clinical 

supervisors and most experienced counselors reported the longest employment in the field 
191

Exhibit 3. Race/Ethnicity*

Supervisor Most Proficient Least Experienced Total

African American 60 56 57 173

Hispanic 28 32 31 91

White 345 305 262 912

Native American 5 8 5 18

Asian/Pacific Islander 3 1 2 6

Other 7 1 1 9

Undeclared 5 5 4 14

TOTAL 453 408 362 1,223

Appendix C – National Validation Study

Exhibit 5. Period of Employment in the Addictions Profession*

Supervisor Most Proficient Least Experienced Total

Less than 6 months 4 10 30 44

6 months to 18 months 13 17 78 108

19 months to 3 years 20 31 68 119

3 to 5 years 49 67 69 185

5 to 10 years 113 159 80 352

More than 10 years 251 126 40 417

TOTAL 450 410 365 1,225

Exhibit 6. Addictions Certification*

Supervisor Most Proficient Least Experienced Total

Certified 308 264 156 728

Not certified 144 141 209 494

TOTAL 452 405 365 1,222

Exhibit 1. Gender*

Supervisor

Most

Proficient

Least

Experienced Total

Male 198 153 130 481

Female 259 259 239 757

TOTAL 457 412 369 1,238

Exhibit 2. Age*

Supervisor

Most

Proficient

Least

Experienced Total

<21 0 0 1 1

21–29 19 30 72 121

30–39 104 112 106 322

40–49 194 169 118 481

50–59 115 79 53 247

60+ 17 18 15 50

TOTAL 449 408 365 1,222

Exhibit 4. Education*

Supervisor Most Proficient Least Experienced Total

GRE/high school diploma 9 6 13 28

Some college or technical/trade school 50 65 70 185

Associate’s degree 23 49 37 109

Bachelor’s degree 112 130 135 377

Graduate degree (master’s level and above) 257 161 110 528

TOTAL 451 411 365 1,227

*Adams and Gallon 1997.
192

Addiction Counseling Competencies

(i.e., more than 5 years). Although “least experienced” was defined as no more than 3 years’ paid 

experience, many “least experienced” counselors reported more than 3 years of employment in 

the addiction profession. This may be the result of a mistaken inclusion of other experiences in 

the field such as volunteer service, internships, or personal treatment and recovery. The least 

experienced counselors had the smallest proportion certified, whereas clinical supervisors had 

the highest proportion certified.

Data reduction procedures. Given the huge number of possible cross-tabulations with a 

survey this size, results have been summarized in three different ways. First, because the purpose of the study was to identify “essential” competencies, survey responses were collapsed into 

percentages of respondents rating each item “4” or “5” (“good” or “excellent”). Excluding the 

“moderate” ratings provides a more stringent standard for judging the content validity of the 

competencies. Second, results were provided for the national sample only. Third, responses 

were summarized across individual competencies within the 12 competency categories.

Validation of the 121 competencies. Internal consistency of the survey was high: Cronbach’s Alpha for the 12 sections of the survey ranged from 0.91 to 0.98. Among the clinical 

supervisors, 40 percent of respondents indicated that entering practitioners needed to be “good” 

or “excellent” in all 121 competencies; 60 percent gave these ratings for 118 of the 121 competencies; and 70 percent gave these ratings for 107 of the 121 competencies. Clearly, the surveyed 

competencies had high content validity for these experienced practitioners.

Gaps between actual and needed competencies. Large differences were found between 

perceived needed and actual proficiency, across all three respondent groups. As exhibit 7 indicates, the gap was most pronounced among clinical supervisors. For all but 1 of the 121 items, 

less than half the supervisors rated actual proficiencies as “good” or “excellent.” Exhibit 8 displays 

the percentage gaps for each of the 12 categories, as reported by clinical supervisors only. Gaps 

between actual and needed proficiencies are evident across categories, ranging from a 44-percent 

gap for the “Referral” category to a 54-percent gap for the “Counseling” category. Just as the 

perceived need for counselor competencies was consistently high, the perceived level of actual

competencies was consistently low.

Congruence among perceptions of counselor groups. As exhibit 7 indicates, although 

the three counselor groups are consistent with one another in their ratings of need, they differ 

consistently in their ratings of actual proficiency. In each category the lowest ratings were given 

by supervisors, followed by “most proficient” and then “least experienced” counselors. Differences between supervisors and least experienced counselors were lowest in the “Treatment 

Planning” category and greatest—not surprisingly—in the “Professional Readiness” category.

Competency subsets. Ratings of some subsets of the competencies indicate a need for 

further study. For example, supervisors and counselors seemed to undervalue competencies 

related to research and treatment outcome assessment. The Committee included these competencies because it felt that the counselors’ abilities to assess and monitor outcomes and apply 

research findings to their own practices were important and would contribute to the professionalization of the field.

In sum, this survey revealed large and consistent gaps between actual and needed competencies 

across all categories, with clinical supervisors perceiving the largest differences. 
193

0%

20%

40%

60%

80%

100%

Understanding Addiction

Treatment

Knowledge

Application to Practice

Professional

Readiness

Clinical

Evaluation

Treatment

Planning

Referral

Case

Management

Counseling

Client, Family, and Community Education

Documentation

Professional and

Ethical

Responsiblities

70.0% 

20.8% 

63.8% 

76.1% 74.5% 74.2% 

64.4% 

72.5% 

76.5% 

67.54% 

78.0% 

80.1% 

17.8% 

66.5% 

15.4% 

25.8% 24.4% 24.5% 20.5% 23.7% 22.3% 21.1% 

25.4% 

30.4% 

Actual Needed

*Adams and Gallon 1997.

0%

20%

40%

60%

80%

100%

Understanding

Addiction

Treatment

Knowledge

Foundations for Addiction Professionals Addiction Counselor Competencies

Application to

Practice

Professional

Readiness

Clinical

Evaluation

Treatment

Planning Referral CaseManagement Counseling Client, Family,and Community

Education

Documentation Professional and

Ethical

Responsiblities

Needed Proficiency

Supervisor Most Proficient Least Experienced

70.0% 71.9% 76.2%

63.8% 67.56% 72.0%

66.5% 68.1% 71.6%

76.1% 79.7% 82.8%

74.5% 78.1% 79.4%

74.2% 74.8% 80.7%

64.4% 66.8% 73.1%

72.5% 72.9% 77.2%

75.5%74.7% 81.2%

67.5% 68.4% 75.8%

 78.0%74.5% 81.3%

 80.1%79.8% 83.6%

0%

10%

20%

30%

40%

50%

Understanding

Addiction

Treatment

Knowledge

Application to

Practice

Professional

Readiness

Clinical

Evaluation

Treatment

Planning Referral CaseManagement Counseling Client, Family,and Community

Education

Documentation Professional and

Ethical

Responsiblities

20.8% 28.9% 33.9%

17.8% 26.6% 30.3%

15.4% 23.2% 28.8%

25.8% 35.3% 43.5%

24.4% 34.3% 39.7%

24.5% 31.7% 33.0%

20.5% 28.5% 31.2%

23.7% 31.2% 36.7%

22.3% 31.0% 38.5%

21.1% 30.5% 37.9%

25.4% 35.5% 40.0%

30.4% 37.9% 44.3%

Actual Proficiency

Foundations for Addiction Professionals Addiction Counselor Competencies

Supervisor Most Proficient Least Experienced

Appendix C – National Validation Study

Exhibit 7. Ratings of Actual vs. Needed Proficiency*

Exhibit 8. Percentage Gap Between Actual and Needed Level as Perceived by Supervisors*

*Adams and Gallon 1997.
194

Addiction Counseling Competencies

Discussion

Clinical supervisors, entry-level counselors, and most proficient counselors endorsed almost all 

121 competencies as important. However, the responses of each professional group also show 

relatively little discrimination among items and categories, which may account for the high 

Alpha coefficients. Given the large number of items in the survey, this level of consistency could 

indicate a substantial halo effect: that is, respondents could have been answering individual 

items on the basis of an overall impression and not making fine discriminations among the 

individual competencies.

The results also indicate large gaps between what is needed and observed in proficiency for 

entry-level counselors, even among entry-level counselors themselves. Supervisors noted the 

greatest gaps, followed by the most proficient and entry-level counselors. Although the least experienced counselors reported the smallest gaps, the gaps were still substantial, indicating that 

what counselors know they need to do the job and what they can do are two different things.

What accounts for supervisors’ ratings of entry-level proficiency being more critical than the 

other respondent groups? One possibility is a contrast effect. That is, supervisors may be using their own level of expertise as the standard for comparison resulting in unrealistically high 

expectations for entry-level counselors. In this instance, counselors with average proficiency 

would receive lower ratings against the supervisors’ higher standard representing significantly 

more experience. 

As a content validation strategy, the survey has limited value. Respondents were given 121 

statements to respond to, and little discrimination among the items was observed. However, 

all the competencies were perceived to be important, and the preparation for each was always 

reported as inadequate. Respondents appeared to address the list as a whole, rather than the 

individual competencies. Those who would embark on curricular change should do the same. 

That is, formal preparation for addiction counselors cannot just be bolstered here and there; it 

needs to be comprehensively redesigned. 

The main benefit of the survey results may be as a catalyst for curricular change. This has already 

proven to be the case. While the survey was being conducted, the Committee was already 

working on an expanded document that listed the knowledge, skills, and attitudes for each of 

the 121 competencies. Feedback from the field was obtained on the draft document. Then the 

International Certification and Reciprocity Consortium (ICRC) convened a national leadership 

group to assess the need for model addiction counselor training. After careful deliberation, the 

group concluded that much of the work to define such a curriculum standard had already been 

accomplished by the Committee and the ICRC in the Committee’s Addiction Counselor Competencies and the ICRC’s 1996 Role Delineation Study, respectively.

Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used 

as a national standard. CSAT convened a panel—The National Steering Committee for Addiction 

Counseling Standards (NSC)—that comprised representatives from five national educational, 

certification, and professional associations. The NSC was successful in achieving unanimous 

endorsement of the Addiction Counselor Competencies—a milestone in the addiction counseling field. In 1998 CSAT published the results of this groundbreaking work as TAP 21: Addiction 

Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice.
195

Appendix C – National Validation Study

The significance of TAP 21 for addiction counseling was that it provided a single frame of 

reference for curriculum development, student advising, professional development, and clinical 

supervision. The current updated edition of TAP 21 continues the work of furthering the 

professionalization of the addiction counseling field.

Conclusions

Although this is a study of perceptions and professional judgment and further inquiry is needed 

into the reasons for the discrepancies, these results suggest that clinical supervisors are getting 

far less than they need in entry-level counselors. More systematic discussions between clinical 

practitioners and faculty of training programs in addiction counseling should produce a 

redefinition of curricular goals based on the competencies described in this document.

Addiction counseling is a profession in the making. Rather than maintaining its professional 

culture by relying on tradition, addiction counseling is building its identity from the ground up, 

by first identifying competencies all addiction counselors are expected to possess. Such an 

approach addresses directly the “education–practice discontinuity” cited by Cavanaugh (1993) 

as one of the most critical problems in professional education. 

References

Adams, R.J., & Gallon, S.L. (1997). Entry Level Addiction Counselor Competency Survey: 

National Results. Portland, OR: Northwest Regional Educational Laboratory.

Addiction Technology Transfer Centers, National Curriculum Committee (1995). 

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Fisher, G. (September 1997). Training Issues for Addiction Counselors and Other Helping 

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International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse (1991). 

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196

Addiction Counseling Competencies

Appendix D – Complete Bibliography

Purposes

This updated version of The Competencies includes bibliographies for each of the four 

transdisciplinary foundations and the eight practice dimensions. Bibliographies appear at the 

end of each section and are combined into a complete, alphabetized list here.

The Competencies bibliographies serve a number of purposes including the following:

X Serving as a guide to educators in teaching and curriculum development

Offering assistance to counselors preparing for certification or licensure exams

Contributing to practitioners’ understanding and knowledge of research- and 

consensus-based practices

Furnishing clinical supervisors with current reading suggestions for supervisees

Providing counselors and other practitioners with a study resource

Supplying administrators with current citations regarding the practice of addiction 

counseling for use in grant preparation.

Literature Search Methodology

This updated version of The Competencies represents the work of two Committees. In 2000, a 

Committee began revising the 1998 version of The Competencies. In 2005, a second Committee was convened to review The Competencies and update the 2000 bibliography.

The bibliographies in The Competencies do not represent a complete reference list of meaningful addiction counseling-related citations. However, they are the result of a thoughtful and 

extensive literature review, and they represent the intent and spirit of The Competencies.

Both literature searches pointed up gaps in literature for several practice dimensions. A scarcity 

of citations was especially notable in the documentation; service coordination; client, family, 

and community education; and referral practice dimensions. Addiction counseling professionals 

might explore these subjects if they are looking for research and writing agendas.

2000 Methodology

The literature search for the 2000 update was conducted by members of the National Addiction 

Technology Transfer Center Curriculum Committee for each transdisciplinary foundation and 

practice dimension. Library facilities at Brown University, the State University of New York at 

Albany, the University of Iowa, the University of Missouri, and the University of Nevada–Reno 

were used. Criteria for the searches specified that resources be the following:

X Timely—no citation published before 1989 unless it was deemed seminal

Empirically sound
197

X Relevant to a particular practice dimension and its associated knowledge, skills, 

and attitudes.

The results of the searches were mixed. Some practice dimensions yielded many citations, 

whereas few relevant citations were found for others. The research methods used also differed 

from institution to institution. The lack of uniformity in search methodology concerned the Committee. Thus, a professional library association specializing in substance abuse—the Substance 

Abuse Librarians and Information Specialists (SALIS), which uses specially trained librarians to 

manage, organize, collect, and distribute substance abuse-related information—was hired. 

SALIS was asked to search materials relevant to the eight practice dimensions using the 

following online databases: 

X Medline

Psych Info

ETOH

ERIC (U.S. Department of Education)

SALIS’s library catalog databases (ADAI Library in Seattle, Washington; Wisconsin 

Clearinghouse Library in Madison, Wisconsin; and Alcohol Research Group in Berkeley, 

California).

Keywords were used to find other relevant terms and articles. Review articles were gleaned for 

items not found with online databases, such as chapters from edited works and government 

documents.

Because large numbers of citations were retrieved for a majority of the practice dimensions, 

SALIS conducted an initial screening of articles based on topic, major researchers, descriptions 

in abstracts, and source documents. Because entire books are rarely found through online 

database literature searches, tables of contents for appropriate books were included from citations found on SALIS catalog databases.

When SALIS completed the search, it provided the Committee with a list of citations and articles 

for each practice dimension. Committee members then reviewed the results of the SALIS literature search. Each article received an independent review by two Committee members based on 

whether it met the following criteria:

X Relevance to the practice dimension being reviewed

Relevance to another practice dimension or transdisciplinary foundation

Empirically or evidence based

Based on clinical practice

Contribution to further understanding of the practice dimension or transdisciplinary 

foundation

Published between 1989 and 2000, unless considered exemplary or a “classic.”

After critiquing both the SALIS-generated articles and articles from the Committee’s initial 

search, the Committee cross-referenced the results of each article’s evaluation. An article was 

selected for inclusion only if two Committee members agreed that it correctly represented the 

intent of a given practice dimension. When consensus was not reached between the primary reviewers, a third Committee member reviewed the article. Articles were considered for inclusion 

Appendix D – Complete Bibliography
198

Addiction Counseling Competencies

only if a third review was positive. Articles found to be irrelevant to the practice dimensions or 

those that did not meet the established criteria were excluded from the bibliography.

2005 Methodology

The literature search for the 2005 update was conducted by the Center for Substance Abuse 

Research (CESAR). The literature search was for each of the four transdisciplinary foundations 

and each of the eight practice dimensions. It covered literature from 2000 to 2005. The literature search used the same methodology as the search conducted in 2000. 

When CESAR completed the search, it provided the Committee with a list of citations and articles for each practice dimension. Committee members also recommended articles that were 

pertinent to a particular practice dimension. Each article received an independent review by 

two Committee members based on the following criteria:

X Relevance to the practice dimension being reviewed

Relevance to another practice dimension or transdisciplinary foundation

Contribution to further understanding of the practice dimension or transdisciplinary 

foundation.

The 2005 Committee followed the same methodology as the 2000 Committee in deciding 

whether to include or exclude articles from the practice dimension bibliographies. Group 

consensus focusing on creating a balanced representation of the available literature was used to 

determine whether to include or exclude books for the transdisciplinary foundation bibliographies. Articles and books selected by the 2005 update Committee were added to the bibliographies created by the 2000 update Committee. 

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Appendix D – Complete Bibliography
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Appendix E – Other Contributors

Research assistance was provided by the following individuals:

Holly M. Anderson, M.S.

Sandra C. Anderson, Ph.D.

Steve Applegate, M.Ed.

Carolyn S. Barrett-Ballinger

Janice S. Bennett, M.S., CSAC

Digna Betancourt-Swingle, M.S.W.

Greg Blevins, Ph.D.

Sandra Brown, Ph.D.

Remi J. Cadoret, M.D.

Donald V. Cline, M.Ed., M.A.

Evadne Cox-McCleary

Thomas M. Delegatto

George De Leon, Ph.D.

Maria Del Mar Garcia, M.S.W., M.H.S.

Dallas M. Dolan, M.S., CCDC, CPC

Catherine Dubé, Ed.D.

Arthur C. Evans, Ph.D.

Linda Foley

Terence T. Gorski, M.S.W.

Paul Grace, M.S.

Rick Gressard, Ph.D., LPC, MAC

Richard Hayton, M.A.

Lorraine K. Hill, M.P.S, MAC, CAAC

Jerome H. Jaffe, M.D.

Steve Jaggers, M.S.

Karen Kelly, Ph.D., MAC, CRPS, CCS, CCJS

Roxanne Kibben, M.A., NCAC I

Gary Lawson, Ph.D.

Judy Lewis, Ph.D.

Bruce Lorenz, NCAC II

Janet Mann

Peter Manoleas, LCSW

Neal McGarry

David Miller, M.A., CSAC II

Merlene Miller, M.A.

Peter Myers, Ph.D.

Peter E. Nathan, Ph.D.

Angie Olson, M.S.

Eileen McCabe O’Mara, Ed.D., MAC

Peter Palanca, M.A., CADC

Jeff Pearcy, M.P.A., CADC III

Paul D. Potter, M.S.W., MAC

Anthony R. Quintiliani, Ph.D., CDAS/HCHS, 

 NCAC II

Nereida Diaz Rodriguez, Ph.D.

Mark Sanders, LCSW, CADC

Kevin R. Scheel, M.S., MAC, LMFT

Arthur J. Schut, M.A.

Howard J. Shaffer, Ph.D.

William L. Shilley, M.A.

Michael Taleff, Ph.D., CAC, MAC

Tom TenEyck, M.A.

Kevin Wadalavage, M.A., CASAC, MCAC

Alicia Wendler, M.A.

Richard Wilson, M.A.

Joan E. Zweben, Ph.D.

Janet Zwick

Christopher Anderson, Ph.D. Candidate

Michelle Burgener, M.A.

Charlotte M. Chapman, LPC, CAC

Deborah Cruze

Claire Imholtz, M.L.S.

Nancy J. Kendall

Michael Mancini, Ph.D. Candidate

Pamela Miles

Andrea Mitchell

Mary O’Malia

Virgie Paul, M.L.S.

Substance Abuse Librarians and Information

 Specialists (SALIS)

Nancy Sutherland

Joycelyn Tucker Burgo, M.A.

Jan Wrolstad, M.Div.

The following individuals served as consultants or field reviewers or contributed in 

other ways to the revisions:

HHS Publication No. (SMA) 08-4171

Substance Abuse and Mental Health Services Administration

First printed 2006

Revised 2007, 2008, 2009, and 2011